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					     20018                    Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations

        The federal credit union adding the                                      SOCIAL SECURITY ADMINISTRATION                                       966–5609 for information about these
     underserved community must                                                                                                                       rules. For information on eligibility,
     document that the community meets the                                       20 CFR Part 404                                                      filing for benefits, or coverage of
     definition for serving underserved areas                                    [Regulations No. 4 and 16]                                           earnings, call our national toll-free
     in the Federal Credit Union Act. The                                                                                                             number, 1–800–772–1213 or TTY (410)
                                                                                 RIN 0960–AE99                                                        966–5609, or visit our Internet web site,
     charter type of a federal credit union
     adding such a community will not                                                                                                                 Social Security Online, at http://
                                                                                 Technical Revisions to Medical Criteria                              www.sss.gov.
     change and therefore the credit union                                       for Determinations of Disability
     will not be able to receive the benefits                                                                                                         SUPPLEMENTARY INFORMATION:    We are
     afforded to low-income designated                                           AGENCY:         Social Security Administration                       revising and making final the rules we
     credit unions, such as expanded use of                                      (SSA).                                                               proposed in the Notice of Proposed
     non member deposits and access to the                                       ACTION:       Final rules.                                           Rulemaking (NPRM) published in the
     Community Development Revolving                                                                                                                  Federal Register on February 11, 2000
                                                                                 SUMMARY: These final rules make a                                    (65 FR 6932).
     Loan Program for Credit Unions.
                                                                                 number of technical revisions to the
        A federal credit union that desires to                                   Listing of Impairments (the listings). We                            Background
     include an underserved community in                                         use the listings when you claim benefits                               Under title II of the Act, we provide
     its field of membership must first                                          based on disability under titles II and                              for the payment of disability benefits if
     develop a business plan specifying how                                      XVI of the Social Security Act (the Act).                            you are disabled and belong to one of
     it will serve the community. The                                            We are making these revisions to reflect                             the following three groups:
     business plan, at a minimum, must                                           advances in medical knowledge,                                         • Workers insured under the Act;
     identify the credit and depository needs                                    treatment and terminology, to clarify                                  • Children of insured workers; and
     of the community and detail how the                                         certain criteria in the listings, to remove
                                                                                                                                                        • Widows, widowers, and surviving
     credit union plans to serve those needs.                                    listings that we rarely use, and to add
                                                                                                                                                      divorced spouses (see 20 CFR 404.336)
     The credit union will be expected to                                        new listings consistent with current
                                                                                                                                                      of insured workers.
     regularly review the business plan, to                                      medical practice. We are making these
                                                                                                                                                        Under title XVI of the Act, we provide
     determine if the community is being                                         individual technical revisions in order
                                                                                                                                                      for Supplemental Security Income (SSI)
     adequately served. The regional director                                    to improve our medical listings and
                                                                                                                                                      payments on the basis of disability if
     may require periodic service status                                         make them easier to understand and
                                                                                                                                                      you have limited income and resources.
     reports from a credit union about the                                       use.
                                                                                                                                                        Under both title II and title XVI
     underserved area to ensure that the                                         DATES: These final regulations are                                   programs, disability must be the result
     needs of the underserved area are being                                     effective May 24, 2002.                                              of any medically determinable physical
     met as well as requiring such reports                                       FOR FURTHER INFORMATION CONTACT:                                     or mental impairment or combination of
     before NCUA allows a federal credit                                         Carolyn Kiefer, Social Insurance                                     impairments that can be expected to
     union to add an additional underserved                                      Specialist, Office of Disability, Social                             result in death or that has lasted or can
     area.                                                                       Security Administration, 3–B–9                                       be expected to last for a continuous
     [FR Doc. 02–9971 Filed 4–23–02; 8:45 am]                                    Operations Building, 6401 Security                                   period of at least 12 months.
                                                                                 Boulevard, Baltimore, Maryland 21235–                                  Our definitions of disability are
     BILLING CODE 7535–01–U
                                                                                 6401, (410) 965–9104 or TTY 1–800–                                   shown in the following table:

                                                                                                                                              Disability means you have a medically determinable im-
               If you file a claim under * * *                                               And you are * * *                                 pairment(s) that meets the statutory duration require-
                                                                                                                                                             ment and results in * * *

     Title II ..........................................................    An adult or a child ....................................          The inability to do any substantial gainful activity
                                                                                                                                                (SGA).
     Title XVI ......................................................       An adult .....................................................    The inability to do any SGA.
     Title XVI ......................................................       A child .......................................................   Marked and severe functional limitations.



        We use a sequential evaluation                                              The listings describe, for each of the                            effect on adults and children, we then
     process, set out in §§ 404.1520 and                                         major body systems, impairments that                                 use the criteria in Part A (see
     416.920 of our regulations, when we                                         we consider severe enough to prevent                                 §§ 404.1525, 404.1526, 416.925, and
     evaluate a claim for disability benefits if                                 you from doing any gainful activity. In                              416.926).
     you are an adult. We use a separate                                         the case of a child applying for SSI                                    The changes we are making in these
     sequential evaluation process described                                     payments based on disability, the
                                                                                                                                                      final rules are not intended to be a
     in § 416.924 of our regulations if you are                                  listings describe impairments that we
                                                                                                                                                      comprehensive update and revision of
     a child claiming SSI payments based on                                      consider severe enough to result in
                                                                                 marked and severe functional                                         the listings. We continue to review each
     disability. At step three of both                                                                                                                of the body system listings to determine
     sequential evaluation processes, we                                         limitations.
                                                                                                                                                      appropriate substantive revisions and
     determine whether you have an                                                  The listings are divided into Part A                              updates. If we determine that more
     impairment(s) that meets or medically                                       and Part B. We apply the medical                                     substantive revisions are necessary, we
     equals the listings. If you are a child                                     criteria in Part A when we assess your
                                                                                                                                                      will publish notices of proposed
     applying for SSI payments based on                                          claim if you are an adult (i.e., a person
                                                                                                                                                      rulemaking in the Federal Register
     disability, we also determine if your                                       age 18 or over). If you are a child, we
                                                                                 first use the criteria in Part B. If the                             describing those proposed revisions and
     impairment(s) functionally equals the                                                                                                            requesting public comments.
     listings.                                                                   criteria in Part B do not apply, and the
                                                                                 specific disease process(es) has a similar


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                       Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations                                          20019

     Explanation of Revisions                                 it merely directs evaluation to listing               medically or functionally equals a
        We are revising language throughout                   2.04, which we are not substantively                  listing). The use of the word ‘‘make’’
     the listings to incorporate imaging                      changing. Listing 2.04 will permit                    may have given the erroneous
     techniques other than x-rays alone. This                 evaluation of this disorder.                          impression that we would automatically
     revised language was incorporated in                        We also removed the word ‘‘organic’’               find medical equivalence in all cases
                                                              in section 2.00B3 and in listing 2.09                 where the impairment(s) was severe but
     the following listing sections: 2.00B2;
                                                              because the cause of the loss of speech               did not meet the exact requirements of
     5.03; 5.04; 5.05; 6.02(C)(1); 7.16; and
                                                              is not material to its evaluation under               a listing.
     9.03. This is being done by adding
                                                              this body system. We also clarified                      For the digestive body systems
     language allowing for ‘‘appropriate
                                                              listing 2.09 to make it clear that the                listings for adults and children, 5.00 and
     medically acceptable imaging’’ to be
                                                              inability to produce by any means                     105.00, we added new listings to
     used when imaging evidence is called
                                                              speech that can be heard, understood, or              address liver transplantation, listings
     for as part of the medical
                                                              sustained is sufficient to meet this                  5.09 and 105.09, respectively. Under
     documentation. Since x-rays are
                                                              listing; all three of these factors do not            these listings, we will consider the
     incorporated in the phrase ‘‘appropriate
                                                              need to be present to meet the listing.               individual to be disabled for 12 months
     medically acceptable imaging,’’ we have                     For the respiratory system listings for            following the date of the liver transplant
     removed the specific mention of ‘‘x-                     adults and children, 3.00 and 103.00,                 surgery. After that period, we will
     rays’’ when we refer to appropriate                      we changed some of the technical                      evaluate any residual impairment.
     medically acceptable imaging                             testing requirements to be simpler and                   For the hemic and lymphatic body
     throughout the listings addressed in this                to be consistent with standard                        system listings, for adults and children,
     rulemaking.                                              laboratory practices. If the spirogram is             we added T-cell lymphoblastic
        We made a revision to our proposed                    generated by any means other than                     lymphoma to listings 7.11 and 107.11,
     rulemaking language in the prefaces of                   direct pen linkage to a mechanical                    respectively. These listings currently
     the listings for the body systems affected               displacement-type spirometer, we will                 address acute leukemia only. We also
     by this change. We added language to                     no longer require separate calibration                included a discussion of T-cell
     explain that appropriate medically                       tracings to be performed at the time                  lymphoblastic lymphoma in the
     acceptable imaging includes, but is not                  each pulmonary function test is                       sections 7.00E and 107.00C of the
     limited to, x-ray imaging, computerized                  performed. Rather, a single daily                     preface to the listings. Because T-cell
     axial tomography (CAT scan) or                           calibration of the testing device will                lymphoblastic lymphoma follows the
     magnetic resonance imaging (MRI), with                   suffice. For direct pen linkage                       same course and requires the same
     or without contrast material,                            spirometry equipment, the tracing is                  treatment as acute leukemia, we believe
     myelography, and radionuclear bone                       directly generated and inherently                     it will simplify adjudication by naming
     scans. To further clarify what we mean                   accurate so that no mechanically                      this particular lymphoma in the listings.
     by ‘‘appropriate,’’ we added a sentence                  generated calibrations are required. We               We also added stem cell transplantation
     to these prefaces that states                            also revised listing section 3.00F so that            as a new medical technique comparable
     ‘‘Appropriate means that the technique                   we no longer require that the algorithm               to bone marrow transplantation in
     used is the proper one to support the                    used to calculate the test for diffusing              listing 7.17.
     evaluation and diagnosis of the                          capacity of the lungs for carbon                         In the skin body system listing, we
     impairment.’’                                            monoxide be provided as part of the                   corrected a spelling error in listing 8.06.
        We made a number of revisions to the                  documentation for this test. Rather, the                 In the endocrine body system listing
     listings for the Special Senses and                      source of the predicted equation should               for adults, we removed paragraph A of
     Speech body systems, 2.00 and 102.00.                    be provided. This information is                      listing 9.02. This listing, which
     We substituted the heading ‘‘Disorders                   sufficient to verify that the test was                addresses progressive exophthalmos as
     of Vision’’ in 2.00A for                                 performed adequately.                                 measured by exophthalmometry, is a
     ‘‘Ophthalmology’’ to make clear that                        We added a new listing for both                    rare complication in light of today’s
     these listings deal with visual disorders,               adults and children to cover lung                     medical treatments for thyroid disease.
     rather than the branch of medicine                       transplants, listings 3.11 and 103.05,                   In the neurological body system
     dealing with the anatomy, physiology,                    respectively. These listings provide that             listings for adults and children, 11.00
     and pathology of the eye. We also                        we will consider an individual to be                  and 111.00, we made a number of
     removed the word ‘‘central’’ when                        disabled for 12 months following the                  changes to reflect current medical
     referring to visual acuity in the preface                date of surgery. After that time, we will             terminology (convulsive and
     sections 2.00A1, 2.00A2, 2.00A5,                         evaluate any residual impairment.                     nonconvulsive epilepsy), and to modify
     2.00A6, 102.00A, listings 2.02 and                          In order to correct a possible                     the documentation requirement for an
     102.02, and in Table No. 1, because the                  misinterpretation in our intent, we                   electroencephalogram (EEG). With the
     word is redundant. It is the loss of                     revised listing sections 4.00A and                    exception of nonconvulsive epilepsy in
     visual acuity in itself (be it central or                104.00A. We now state that we will                    children, we will no longer require that
     peripheral) that results in the inability                ‘‘consider’’ (rather than ‘‘make’’) a                 an EEG be part of the documentation
     to distinguish detail, and thereby                       medical equivalence finding for an                    needed to support the presence of
     prevents reading and fine work. We                       adult, and a medical or functional                    epilepsy. An EEG is a definitive
     further clarify this in a revision to                    equivalence finding for a child seeking               diagnostic tool in cases of
     section 2.00A2 which states that ‘‘Loss                  SSI payments, in situations where the                 nonconvulsive epilepsy in children, but
     of visual acuity may result in impaired                  individual has either a medically                     it is rare for an EEG to confirm epilepsy
     distant vision or near vision, or both.’’                determinable impairment that is not                   in its other forms for either adults or
     We also clarified listing 2.04 by                        listed, or has a combination of                       children. In listings 11.02 and 11.03, we
     replacing the phrase ‘‘central visual                    impairments, no one of which meets a                  changed the terminology to reflect
     efficiency’’ with the phrase ‘‘visual                    listing. We have always intended that                 convulsive and nonconvulsive epilepsy,
     acuity efficiency.’’ We removed listing                  we consider whether the impairment or                 and we made comparable changes to the
     2.05, Complete homonymous                                combination of impairments medically                  childhood epilepsy listings. We also
     hemianopsia, as a separate listing since                 equals a listing (or, as appropriate,                 changed references to ‘‘anticonvulsive’’


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     20020             Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations

     treatment to ‘‘antiepileptic’’ treatment                    Several commenters simply expressed                concern that chronic osteomyelitis was
     and ‘‘antiepileptic’’ drugs. These                       agreement with the proposed changes,                  not listed because she knew of
     changes are consistent with current                      believed that they would be beneficial,               situations in which treatment did not
     medical usage.                                           and stated that the language was                      eliminate the infection.
        We changed listing 111.02B3 to refer                  improved so that it was easier to                        Response: We have not adopted these
     to a ‘‘Significant mental disorder’’ for                 understand. Along this line, some of                  comments. We have not included any
     consistency with other listing                           these commenters specifically                         technical revisions to the
     terminology, for example, that of listings               supported our proposal to update the                  musculoskeletal body system listings in
     111.07B3 and 4, and to clarify that we                   language in our listings concerning                   these final rules. On November 19,
     require a defined mental impairment in                   imaging techniques to include other                   2001, we published final rules in the
     order to fulfill this listing criteria for               appropriate medically acceptable                      Federal Register revising the medical
     convulsive epilepsy.                                     imaging techniques in addition to x-                  criteria we use for evaluating
        We eliminated current listing 11.15                   rays. These commenters believed this                  musculoskeletal impairments in adults
     for tabes dorsalis because this disease is               was an improvement that would be                      and children. In those final rules, we
     rarely seen today, given the availability                beneficial for both claimants and                     noted that we removed listings 1.08 and
     of effective medical screening and                       adjudicators.                                         101.08, osteomyelitis or septic arthitis,
     treatment for syphilis. With this                           A few commenters, however, stated                  because fundamental advances in
     deletion, we also amended listing 11.17                  that the proposed revisions to the                    antibiotic therapy has meant that, when
     by removing the reference to listing                     listings were difficult to read and                   they do occur, these conditions are not
     11.15B currently in listing 11.17A. The                  understand. These commenters                          usually expected to last for one year.
     current reference to listing 11.04B                      recommended that the listings be                      Therefore, we will evaluate claims
     contained in listing 11.17 adequately                    written to be understandable to lay                   involving these impairments on a case-
     addresses the disorganization of motor                   people, rather than to doctors. Since the             by-case basis to determine whether they
     function that is needed to evaluate the                  listings summarize required medical                   medically equal (or, as appropriate,
     effects of these degenerative diseases on                signs, laboratory findings, and                       functionally equal) the listings (66 FR
     an individual’s gait.                                    symptoms, we often find it necessary to               58010).
        In the neoplastic diseases body                       retain appropriate medical terms and                     Comment: One commenter suggested
     system listings for adults, 13.00, we                    language in the listings. To the extent               that we make an additional change to
     amended listing 13.08 to add the                         possible, we write our regulations in                 listing 1.11, fracture of the femur, tibia,
     criterion, ‘‘Anaplastic (undifferentiated)               plain language. We intend to                          tarsal bone, or pelvis, to include the
     carcinoma of the thyroid,’’ and                          incorporate as much plain language as                 non-union of the distal fibula.
     designated it as listing 13.08A. This is                 possible as we review and revise each                    Response: This listing, which is now
     a distinct type of thyroid carcinoma                     individual body system listing, and we                listing 1.06 as a result of the final rules
     with a poor prognosis, and it is of the                  wrote these proposed revisions as                     that we published on November 19,
     same level of severity as the current                    simply as possible within the context of              2001, addresses the major bones of the
     thyroid listing. By identifying this type                the listing being revised.                            lower extremities that are usually
     of carcinoma specifically, we believe we                    The following are summaries of                     involved in weight bearing. While we
     will simplify adjudication for these                     comments that directly related to the                 did not specifically include reference to
     types of cases.                                          proposed rules, or related to areas that              situations involving non-union of the
        For clarity, we refer to the changes we               were discussed in the proposed rules,                 distal fibula, a case of this type that
     are making here as the ‘‘final’’ rules and               along with our responses. Because some                fulfilled the overall severity
     to the rules that will be changed by                     of the comments were lengthy, we have                 requirements of listing 1.06 could be
     these final rules as the ‘‘current’’ rules.              condensed, summarized and                             found to medically equal this listing.
     However, these final rules do not go into                paraphrased them. We have tried,
     effect until 30 days after the date of this                                                                    Special Senses and Speech
                                                              however, to summarize the commenters’
     publication. Therefore, the ‘‘current’’                  views accurately, and to respond to all                  Comment: One commenter
     rules will still be in effect until that                 of the significant issues raised by the               recommended that we make changes to
     date.                                                    commenters that were within the scope                 listing 2.09 in addition to the ones we
                                                              of these rules. Many of the comments,                 proposed. This commenter first
     Public Comments                                                                                                suggested that we clarify the term
                                                              however, pertained to matters that were
       On February 11, 2000, we published                     not within the scope of these proposed                ‘‘sustained’’ in listing 2.09. This
     a notice of proposed rulemaking                          rules. We referred those comments to                  commenter also expressed concern that,
     (NPRM) in the Federal Register (65 FR                    the appropriate components of the                     if the term ‘‘organic’’ was deleted from
     6929) proposing to make a number of                      Social Security Administration and do                 listing 2.09, the rules should also clarify
     technical revisions to our listings. We                  not address them in this preamble.                    whether all known means to produce
     gave interested persons 60 days within                                                                         speech must have been tried and failed.
     which to submit written comments on                      Musculoskeletal Body System                           Finally, the commenter recommended
     the proposed rules; the comment period                      Comment: Two commenters requested                  that we include language from the
     closed on April 11, 2000. We received                    that we make additional changes to the                preamble to the NPRM in the final rules,
     90 comments from the public. Most of                     listings on the evaluation of                         either in listing 2.09 or in the
     the comments came from disabled                          osteomyelitis (listings 1.08 and 101.08).             introductory section of the listing,
     individuals. Other comments came from                    One commenter recommended that we                     section 2.00B3. The commenter stated
     State agencies that make disability                      include the spinal manifestations of the              that we should include in the regulatory
     determinations for us, advocacy                          disorder in the listings. The other                   text the statement that, ‘‘We believe that
     organizations, and professional                          commenter suggested that we clarify the               any one of these factors is sufficient to
     organizations whose members have                         reference to a ‘‘major joint of an upper              establish that an individual has a
     interests and responsibilities that                      or lower extremity’’ in listing 1.08, since           listing-level impairment.’’
     require them to have some expertise in                   osteomyelitis involves bones, not joints.                Response: We have not adopted these
     the evaluation of disability claims.                     The first commenter also expressed                    comments. Revised listing 2.09 makes


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                       Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations                                         20021

     clear that the inability to produce                         Comment: One commenter                             medically equaled other neurological
     speech linked to any of the three factors                recommended that we continue to use                   listings. For example, sensory deficits
     (can be heard, can be understood, or can                 the term ‘‘Ophthalmology’’ instead of                 associated with tabes dorsalis could be
     be sustained) will satisfy the                           our proposed revision, ‘‘Disorders of                 evaluated under listing 11.04A, or
     requirements of the listing. We do not                   Vision,’’ for the heading of listing                  visual limitations associated with this
     believe that adding the sentence from                    section 2.00A. Similarly, another                     condition could be evaluated using
     the preamble to the proposed rules, as                   commenter thought we should use the                   listing 11.09B.
     the commenter suggested, clarifies the                   term ‘‘Visual Impairment’’ rather than                   Comment: One commenter, from an
     rule any further. The other issues raised                ‘‘Disorders of Vision.’’ This commenter               advocacy organization on behalf of
     by this commenter will require more                      stated that this was consistent with                  individuals with epilepsy, commended
     extensive revisions to the special senses                terminology used by schools and most                  the proposed change of wording to use
     and speech listings than were intended                   rehabilitation facilities.                            ‘‘antiepileptic’’ in place of
     under this rulemaking proceeding. We                        Response: We have not adopted these                ‘‘anticonvulsant.’’ Another commenter,
     will consider more detailed                              comments. As we noted above, we                       however, stated that the change would
     clarifications as part of our review of the              believe our use of more common                        limit the listing, because convulsive
     special senses and speech body system                    terminology is suitable for our purposes.             disorders other than epilepsy would no
     listings.                                                We also believe that changing our                     longer fall under this listing section.
        Comment: Some commenters                              heading of listing section 2.00A to                   The first commenter also supported the
     expressed concern about the changes we                   ‘‘Disorders of Vision’’ is appropriate to             elimination of the requirement for an
     proposed to listing section 2.00, on the                 convey our identification of the material             electroencephalogram (EEG) in all
     evaluation of vision disorders. One                      in this section of the listings.                      diagnoses of epilepsy. However, this
     commenter recommended that section                          Comment: One commenter stated that                 commenter also expressed concern that
     2.00A1 not be revised to remove the                      we should revise our measurement                      we did not change some other outdated
     word ‘‘central’’ when referring to vision                assessment tools for the peripheral field             terminology contained in the epilepsy
     and visual acuity because the terms                      and for central visual function, and                  listings, and recommended that we
     ‘‘central vision’’ and ‘‘visual acuity’’ are             eliminate the use of the Goldmann                     make additional changes to the listings.
     not medically synonymous. The                            perimeter and the Snellen visual acuity                  Response: We agree with the
     commenter noted that it is possible to                   tests. Another commenter agreed that                  commenter about the need to make
     have a small island of usable vision in                  we should revise our rules on the use of              additional revisions to the listings for
     the center of a dense central field loss.                the Goldmann perimeter in light of our                epilepsy in order to further update
     This could result in measurable but                      emphasis on changes in the listings to                them. We are in the process of
     unusable central visual acuity. This                     reflect advances in medical knowledge.                reviewing and revising the neurological
     could potentially occur in cases                            Response: We have not adopted these                body system listings and expect to issue
     involving impairments such as macular                    comments. These comments raise issues                 proposed rules as part of that revision.
     degeneration, diabetic retinopathy, end-                 that are outside the scope of this                    We expect that any future revisions will
     stage glaucoma, end-stage retinitis                      rulemaking proceeding. We will                        address the commenter’s concerns.
     pigmentosa, and ischemic vision loss.                    consider the concerns the commenters                  Because the changes the commmenter
     The commenter also stated that the term                  expressed as we consider more                         suggested are more detailed and
     ‘‘peripheral fields’’ was unclear. The                   substantive revisions to the special                  substantive, we do not believe that these
     second commenter, an ophthalmologist,                    senses and speech body system listings.               suggested changes are within the scope
     expressed similar concerns. He                                                                                 of this rulemaking proceeding. In regard
     commented that we were not using                         Digestive System                                      to the concern that these proposed
     accurate terminology when we proposed                      Comment: One commenter suggested                    changes would limit the usefulness of
     to use the terms ‘‘visual acuity’’ and                   that we include other diagnostic                      the seizure listings, the primary disorder
     ‘‘peripheral fields.’’                                   techniques, such as a CAT scan or                     being addressed here is in fact epilepsy.
        Response: We have not adopted these                   ultrasound, as acceptable confirmation                Other convulsive disorders or similarly
     comments. While we understand the                        of liver disease, in addition to a liver              disruptive disorders can still be
     commenters’ concerns, our use of the                     biopsy, under listing 5.05F.                          evaluated under these epilepsy listings
     terms we proposed in this section of the                   Response: We have not adopted this                  by using medical equivalence, as has
     preface is consistent with common                        comment because it is beyond the scope                been done in the past with such
     definitions which satisfy our needs for                  of this rulemaking proceeding. We will,               disorders as narcolepsy and
     purposes of disability adjudication. We                  however, consider the comment as part                 pseudoseizures.
     agree that vision physiologists might                    of our comprehensive review of the                       Comment: One commenter stated that
     prefer to use more sophisticated                         digestive system listings.                            we should use the terms ‘‘partial’’
     terminology in accordance with their                                                                           seizures and ‘‘generalized’’ seizures in
     professional needs to discern complex                    Neurological                                          the listings, rather than ‘‘convulsive
     distinctions. However, for purposes of                      Comment: One commenter                             epilepsy’’ (listing 11.02) and
     disability adjudication, our use of the                  recommended that we revise the preface                ‘‘nonconvulsive epilepsy’’ (listing
     terms ‘‘visual acuity’’ and ‘‘peripheral                 to the listing to reflect the deletion of             11.03).
     fields’’ are familiar and defined                        listing 11.15, for tabes dorsalis.                       Response: As noted above, we are
     concepts. We believe, based on our                          Response: We have not adopted this                 currently reviewing the entire
     program experience, that they                            comment. Listing 11.15 is not discussed               neurological body system to identify
     adequately satisfy our needs in                          in the preface to the current                         further appropriate revisions. As part of
     evaluating disability claims of                          neurological listings, and we see no                  this process, we anticipate some
     individuals with visual impairments.                     need to add a discussion regarding its                restructuring of listings using broader
     However, we will consider these                          deletion. Tabes dorsalis is rarely seen in            impairment categories, as well as
     comments when we review and revise                       modern medicine. If we had to evaluate                additional changes in the listings
     the special senses and speech body                       this condition, it would be appropriate               dealing with epilepsy and terminology
     system listings.                                         to consider whether the condition                     related to epilepsy. We will consider the


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     20022             Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations

     commenter’s recommendations during                       mental retardation is significantly                   complete homonymous hemianopsia
     the review of the entire neurological                    subaverage general intellectual                       and listing 11.15 for tabes dorsalis, and
     body system listings.                                    functioning (further defined as an IQ                 the removal of the reference in listing
        Comment: One commenter expressed                      standard score of approximately 70 or                 9.02 to ‘‘progressive exophthalmos as
     concern that we were removing                            below), that is accompanied by                        measured by exophthalmometry.’’ The
     myasthenia gravis from the listings as a                 significant limitations in at least two of            commenter agreed that these conditions
     listed impairment.                                       the following skill areas:                            were rarely seen, but remained
        Response: We did not propose                          communication, self-care, home living,                concerned that their removal may lead
     removing this impairment as a listed                     social/interpersonal skills, use of                   to these conditions being overlooked.
     impairment in our regulations.                           community resources, self-direction,                  The commenter recommended that any
     Myasthenia gravis is evaluated under                     functional academic skills, work,                     revisions to these listings be done as we
     listing 11.12.                                           leisure, health, and safety. The onset                revise individual body system listings.
        Comment: One commenter questioned                     must occur before age 18 years.’’                        Response: We have not adopted these
     when we would recognize post-polio                          Following publication of this new                  comments. We believe it is appropriate
     syndrome as a disabling impairment,                      definition of MR by the AAMR, the                     to delete listings 2.05 and 11.15 and to
     since the neuromuscular effects result in                American Psychological Association                    remove the reference to progressive
     additional functional loss and are                       published its own ‘‘Manual of Diagnosis               exophthalmos in listing 9.02 as part of
     usually permanent and slowly                             and Professional Practice in Mental                   these final rules. All of these conditions
     progressive.                                             Retardation, 1996.’’ It states: ‘‘Mental              are extremely rare and are amenable to
        Response: The late effects of polio,                  retardation refers to (a) significant                 treatment, given modern medical
     also referred to as post-polio syndrome                  limitations in general intellectual                   practices. The listings are intended to
     or sequelae, are recognized as a                         functioning; (b) significant limitations              identify commonly occurring and
     potentially disabling impairment and                     in adaptive functioning, which exist                  frequently seen impairments that are
     are evaluated under our current listing                  concurrently; and (c) onset of                        considered severe enough to preclude
     11.11, Anterior poliomyelitis. Under                     intellectual and adaptive limitations                 any gainful activity in adults (or that
     listing 11.11, we evaluate your overall                  before the age of 22 years.’’ In its                  result in ‘‘marked and severe functional
     motor function. If the impairment is not                 definition, (a) is defined as ‘‘* * * an              limitations’’ in children). We do not
     found to meet or equal a listed                          IQ or comparable normed score that is                 believe there is any benefit in waiting to
     impairment, we consider the impact of                    two or more standard deviations below                 delete these listings until we revise the
     the impairment and any related                           the population mean for the measure;’’                specific body system listings.
     symptoms in determining your residual                    and for (b), ‘‘* * * the criterion of                    Comment: A number of commenters
     functional capacity and we proceed to                    significance is a summary index score                 requested that other specific
     evaluate your impairment under our                       that is two or more standard deviations               impairments be included in the listings.
     sequential evaluation procedures in                      below the mean * * *.’’                               The commenters suggested that we add
     accordance with § 404.1545.                                 The definition of MR used by SSA in                a number of impairments that are not
                                                              the listings is not restricted to diagnostic          now included in the listings, such as
     Mental
                                                              uses alone, nor does it seek to endorse               Lyme disease, trigeminal neuralgia,
       Comment: One commenter                                 the methodology of one professional                   chronic fatigue syndrome (CFS),
     recommended that we use the definition                   organization over another. While                      fibromyalgia, systemic mastocytosis,
     of mental retardation (MR) found in the                  capturing the essence of the definitions              migraines, vestibular disorders, reflex
     Diagnostic and Statistical Manual of                     used by the professional organizations,               sympathetic dystrophy syndrome,
     Mental Disorders (4th ed. 1994) (DSM–                    it also is used to determine eligibility for          narcolepsy, arachnoiditis, porphyria,
     IV), published by the American                           disability benefits. SSA’s definition                 and hepatitis A, B, and C. The
     Psychiatric Association, as the                          establishes the necessary elements,                   commenters believe that these
     definition of MR in listing 12.05 and                    while allowing use of any of the                      impairments are medically severe and
     112.05.                                                  measurement methods recognized and                    result in substantial functional loss due
       Response: We did not adopt the                         endorsed by the professional                          to the illnesses themselves as well as the
     comment. The definition of MR we use                     organizations.                                        associated symptoms and side effects
     in our listings is consistent with, if not                                                                     from various treatments. They requested
     identical to, the definitions of MR used                 Neoplastic Diseases—Malignant                         that specific listing criteria be included
     by the leading professional                                 Comment: One commenter requested                   in our listings so that individuals with
     organizations. The four major                            that we add ‘‘undifferentiated’’                      these disorders could be found disabled
     professional organizations in the United                 carcinoma of the thyroid to the listing               as appropriate and would not be
     States that deal with MR have each                       13.08. The commenter noted that this                  overlooked solely due to the fact that
     established their own definition of MR.                  would be the same as the proposed                     their specific impairments were not
     While all the definitions require                        anaplastic carcinoma of the thyroid, but              named in the listings.
     significant deficits in intellectual                     the inclusion of both terms would better                 Response: We did not adopt these
     functioning, as evidenced by IQ scores                   clarify the rules.                                    comments, which are outside the scope
     of approximately 70 or below, age of                        Response: We have adopted this                     of this rulemaking proceeding. In
     onset and the method of measuring the                    comment and have made the change in                   proposing these revisions, we intended
     required deficits in adaptive functioning                listing 13.08.                                        primarily to address existing listings
     differ among the organizations.                                                                                and to update or clarify the medical
       For example, the definition of MR                      General                                               terminology used in some listings. We
     used in the DSM–IV is predominantly                        Comment: A professional organization                explained in the NPRM that more
     based on (but not identical to) the                      representing disability adjudicators at               substantive changes to the listings
     revised definition of MR promulgated                     the state level generally agreed with the             would be addressed when we reviewed
     by the American Association on Mental                    proposed revisions. However, the                      the listing criteria for each individual
     Retardation (AAMR) in 1993. The DSM–                     comments expressed concern about the                  body system (65 FR 6929). We will
     IV states: ‘‘The essential feature of                    proposed deletion of listing 2.05 for                 consider including new criteria for


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                       Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations                                         20023

     specific impairments, such as those                      most recent favorable decision. See                   benefit you as well as any adverse side
     mentioned above, as we review the                        §§ 404.1594(c)(3)(i) and                              effects you may experience. We evaluate
     appropriate respective body systems.                     416.994(b)(2)(iv)(A) of our regulations.              your impairment in light of the
        However, we emphasize that if you                     A similar provision for CDRs for                      medications or treatments that you have
     have an impairment(s) that is not                        children eligible for SSI based on                    been provided by your medical sources.
     included in the listings, you may still be               disability appears in § 416.994a(b)(2) of             We do not judge the appropriateness of
     found disabled at the third step of the                  our regulations.                                      such medications or treatments.
     sequential evaluation processes for                         As we noted in the effective date
     adults and children if your                              section of this preamble, these final                 Other Changes
     impairment(s) medically equals a                         rules will be effective on May 24, 2002.                 We proposed several changes to the
     listing. This longstanding policy is                     Our current rules will continue to apply              listings that we are not making in these
     explained in §§ 404.1526 and 416.926 of                  until the effective date of these final               final rules. The NPRM contained a
     our regulations. If you are a child under                rules. When these final rules become                  drafting error in reference to section
     age 18, we may also find that an                         effective, we will apply them to new                  11.02 addressing epilepsy. We proposed
     impairment or combination of                             applications filed on or after the                    to revise the heading to be more
     impairments functionally equals the                      effective date of the rules. We will also             consistent with current medical
     listings, as explained in § 416.926a of                  apply them to the entire period at issue              technology, but we had not intended to
     our regulations. In addition, if you are                 for claims that are pending at any stage              change the frequency criterion for the
     an adult, we can find you disabled at a                  of our administrative review process,                 number of seizures required to meet this
     later step in the sequential evaluation                  including claims that are pending                     listing. The proposed rules incorrectly
     process, as explained in §§ 404.1545–                    administrative review after remand from               stated the frequency as ‘‘occurring more
     404.1568 and 416.945–416.968 of our                      a Federal court.                                      frequently than once weekly.’’ (65 FR
     regulations. With respect to the specific                   With respect to claims in which we                 6935). We did not intend to change the
     impairments noted by the commenters,                     have made a final decision, and that are              existing frequency criterion, which
     a Social Security Ruling (SSR), SSR 99–                  pending judicial review in Federal                    continues to read, ‘‘occurring more
     2p (64 FR 23380), provides detailed                      court, we expect that the court’s review              frequently than once a month.’’ We have
     guidance on how we evaluate claims                       of the Commissioner’s final decision                  revised the final rules consistent with
     involving CFS.                                           would be made in accordance with the                  our original intent.
        Comment: Several commenters                           rules in effect at the time of the final                 Second, the NPRM proposed revising
     suggested that we make specific changes                  decision. If the court determines that the            § 416.926a(d) to remove subparagraphs
     to listings that we did not propose                      Commissioner’s final decision is not                  (8) and (9) of this section and revise the
     changing in the proposed rules.                          supported by substantial evidence, or                 numbering accordingly. On June 14,
        Response: We did not adopt these                      contains an error of law, we would                    2000, we published a notice of intent to
     comments, which are also outside the                     expect that the court would reverse the               issue regulations and request for
     scope of this rulemaking proceeding.                     final decision, and remand the case for               comments that asked experts in growth
     However, we will consider the                            further administrative proceedings                    impairments in children, and other
     commenters’ proposed changes as we                       pursuant to the fourth sentence of                    interested members of the public, for
     revise individual body system listings.                  section 205(g) of the Act, except in those            comments on how we should revise the
        Comment: A few commenters were                        few instances where the court                         childhood growth impairment listings
     concerned that individuals would lose                    determines that it is appropriate to                  (65 FR 37321). We will consider
     their benefits based on the proposed                     reverse the final decision and award                  whether and how we should revise
     technical changes to the listings.                       benefits, without remanding the case for              these examples of growth impairments,
        Response: No individual’s disability                  further administrative proceedings. In                which we consider to functionally equal
     benefits will be ceased solely on the                    those cases decided by a court after the              the listings, in the context of that
     basis of these technical revisions to the                effective date of the rules, where the                rulemaking proceeding. As a result, we
     listings. We conduct periodic reviews of                 court reverses the Commissioner’s final               are not making any changes to
     individuals receiving benefits to                        decision and remands the case for                     § 416.926a in these final rules. Former
     determine whether they are still                         further administrative proceedings, on                § 416.926a(d)(8) and (9) were
     disabled. These reviews are known as                     remand, we will apply the provisions of               redesignated as § 416.926a(m)(7) and
     continuing disability reviews (CDRs).                    these final rules to the entire period at             (m)(8), respectively, in the final
     However, when we conduct CDRs, we                        issue in the claim.                                   childhood disability rules that we
     do not find that your disability has                        Comment: One commenter felt that                   published on September 11, 2000 (65 FR
     ended based on a change in a listing. In                 these proposed revisions were                         54747). Those final rules were effective
     most cases, we must show that your                       structured to take disability benefits                on January 2, 2001.
     impairment(s) has medically improved                     away from individuals who were                           Third, we have not included the
     and that this improvement is ‘‘related to                stabilized by medications. This                       technical revisions involving the adult
     the ability to work.’’ If your                           individual felt that medications had                  mental disorders body system listings
     impairment(s) has not medically                          masked the severity of his liver disease              (section 12.00) in these final rules. On
     improved, we will generally find that                    and this had adversely affected his                   August 21, 2000, we published final
     you are still disabled. Even if the                      ability to receive a transplant.                      rules revising the medical criteria we
     impairment(s) has medically improved,                       Response: These proposed revisions                 use for evaluating mental disorders and
     our regulations provide that the                         are not in any way intended to change                 traumatic brain injury in adults (65 FR
     improvement is not ‘‘related to the                      the way we evaluate the impairment(s)                 50746). In those final rules, we made
     ability to work’’ if the impairment(s)                   of individuals who benefit from                       several revisions to listing 12.05,
     continues to meet or equal the ‘‘same                    prescribed medication(s). In evaluating               including a revision to the capsule
     listing section used to make our most                    any medical impairment, we must                       definition to the listing. Consequently,
     recent favorable decision.’’ This is true                consider the impact of any treatments                 there is no need to include any
     even if we have deleted or revised the                   and medications that you are taking,                  additional changes to that listing in
     listing section that we used to make the                 both from the standpoint of how they                  these final rules.


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     20024             Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations

        Fourth, we did not include the                        requirement(s) contained in these rules.              Appendix 1 to Subpart P of Part 404—
     technical revisions involving the                        We are seeking clearance of the burdens               [Amended]
     musculoskeletal body system listings                     referenced in these rules because these                  2. Appendix 1 to subpart P of part 404
     (section 1.00 and 101.00) for adults and                 rules were not considered during the                  is amended as follows:
     children in these final rules. On                        clearance of the forms. An Information                   A. In part A:
     November 19, 2001, we published final                    Collection Request has been submitted                    1. Section 2.00 is amended:
     rules revising the medical criteria we                   to OMB. While these rules will be                        a. By revising the heading of
     use for evaluating musculoskeletal                       effective 30 days from publication, these             paragraph A;
     disorders in adults and children (66 FR                  burdens will not be effective until                      b. By revising paragraph A1, the first
     58010). In those final rules, we made the                cleared by OMB. We are soliciting                     two sentences of paragraph A2, and
     revisions we had proposed in this                        comments on the burden estimate; the                  paragraph A5;
     rulemaking proceeding.                                   need for the information; its practical                  c. By amending the first, fourth, fifth,
        However, the language we used in the                  utility; ways to enhance its quality,                 and sixth sentences of paragraph A6 to
     final rules revising the musculoskeletal                 utility and clarity; and on ways to                   remove the word ‘‘central’’;
     listings to describe what we mean by                     minimize the burden on respondents,                      d. By revising the last sentence in the
     appropriate medically acceptable                         including the use of automated                        second undesignated paragraph of
     imaging techniques should also be                        collection techniques or other forms of               paragraph B2 and by amending the
     included in the preface of other body                    information technology. We will                       second undesignated paragraph of
     systems that refer to imaging                            publish a notice in the Federal Register              paragraph B2 to add two new sentences
     techniques. Accordingly, we added this                   upon OMB approval of the information                  at the end of the paragraph;
     language to the prefaces of those body                                                                            e. By revising paragraph B3;
                                                              collection requirements. Comments                        2. Section 2.02 is amended by
     systems that we address in this                          should be submitted to the OMB desk
     rulemaking proceeding as part of these                                                                         removing the word ‘‘central’’ in the
                                                              officer for SSA within 30 days of                     heading.
     final rules. We will also add it as                      publication of this final rule at the
     needed to other body system listings as                                                                           3. Section 2.04 is revised.
                                                              following address: Office of                             4. Section 2.05 is removed and
     we revise them in the future. The                        Management and Budget, Attn: Desk
     addition of this language allows us to                                                                         reserved.
                                                              Officer for SSA, New Executive Office                    5. Section 2.09 is revised.
     delete the specific references to ‘‘x-rays’’
                                                              Building, Room 10235, 725 17th St.,                      6. Table No. 1 following section 2.09
     in listing sections 2.00B2 and 113.00A,
                                                              NW, Washington, DC 20503.                             is amended by revising the heading to
     and to delete the phrase ‘‘x-ray imaging’’
     previously included in listings 5.03,                    (Catalog of Federal Domestic Assistance               read: ‘‘PERCENTAGE OF VISUAL
     5.04, 5.05, and 105.05.                                  Program Nos. 96.001, Social Security-                 ACUITY EFFICIENCY
        Aside from those changes noted                        Disability Insurance; 96.002, Social Security-        CORRESPONDING TO VISUAL
     above, we are not making any other                       Retirement Insurance; 96.004, Social                  ACUITY NOTATIONS FOR DISTANCE
     changes to the proposed revisions.                       Security-Survivors Insurance; 96.006,                 IN THE PHAKIC AND APHAKIC EYE
                                                              Supplemental Security Income)                         (BETTER EYE)’’; by revising the heading
     Regulatory Procedures                                                                                          of the right column on the first line of
     Executive Order 12866                                    List of Subjects in 20 CFR Part 404                   the table to read, ‘‘PERCENT VISUAL
                                                                                                                    ACUITY EFFICIENCY’’; and by
       The Office of Management and Budget                      Administrative practice and                         amending footnotes 2 and 3 to Table No.
     (OMB) has reviewed these final rules in                  procedure, Blind, Disability benefits,                1 by removing the word ‘‘central.’’
     accordance with Executive Order (E.O.)                   Old-Age, Survivors and Disability                        7. Section 3.00 is amended by revising
     12866, as amended by E.O. 13258. We                      Insurance, Reporting and recordkeeping                the last sentence in the second
     have also determined that these rules                    requirements, Social Security.                        undesignated paragraph of paragraph E,
     meet the plain language requirements of                    Dated: February 12, 2002.                           and by amending paragraph F1 by
     E.O. 12866.                                                                                                    revising the fourth and fifth sentences of
                                                              Jo Anne B. Barnhart,
     Regulatory Flexibility Act                                                                                     the fourth undesignated paragraph.
                                                              Commissioner of Social Security.
                                                                                                                       8. Section 3.11 is added.
        We certify that these final rules will                                                                         9. Section 4.00, paragraph A, is
     not have a significant economic impact                      For the reasons set forth in the
                                                                                                                    amended by revising the second
     on a substantial number of small entities                preamble, part 404, subpart P of chapter
                                                                                                                    sentence of the third undesignated
     because these rules affect only                          III of title 20 of the Code of Federal
                                                                                                                    paragraph, and paragraph C3 is
     individuals. Therefore, a regulatory                     Regulations is amended as follows:
                                                                                                                    amended by revising the third sentence
     flexibility analysis as provided in the                                                                        of the paragraph and adding two new
     Regulatory Flexibility Act, as amended,                  PART 404—FEDERAL OLD–AGE,
                                                              SURVIVORS AND DISABILITY                              sentences.
     is not required.                                                                                                  10. Section 5.00, paragraph C, is
                                                              INSURANCE (1950–)
     Paperwork Reduction Act                                                                                        amended by revising the fourth sentence
                                                              Subpart P—Determining Disability and                  and by adding two new sentences.
       These final rules contain reporting                                                                             11. Section 5.03 is revised.
     requirements at: 2.00B; 3.00F; 11.02;                    Blindness
                                                                                                                       12. Section 5.04 is amended by
     11.03; 14.00B; 14.08M; 100.00B;                                                                                revising the heading and by revising
     102.00A; 104.00E; 105.00B; 111.00A;                        1. The authority citation for subpart P
                                                                                                                    paragraph C.
     and 113.00B; 114.00B; and 114.08N.                       of part 404 continues to read as follows:                13. Section 5.05 is amended by
     The public reporting burden is                             Authority: Secs. 202, 205(a), (b), and (d)–         revising the first sentence in paragraph
     accounted for in the Information                         (h), 216(i), 221(a) and (i), 222(c), 223, 225,        A.
     Collection Requests for the various                      and 702(a)(5) of the Social Security Act (42             14. Section 5.09 is added after the
     forms that the public uses to submit the                 U.S.C. 402, 405(a), (b), and (d)–(h), 416(i),         tables.
     information to SSA. Consequently, a 1-                   421(a) and (i), 422(c), 423, 425, and                    15. Section 6.00 is amended by
     hour placeholder burden is being                         902(a)(5)); sec. 211(b), Pub. L. 104–193, 110         adding two new sentences to paragraph
     assigned to the specific reporting                       Stat. 2105, 2189.                                     A.


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                       Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations                                                 20025

        16. Section 6.02 is amended by                           6. Section 103.00, paragraph E, is                     level of severity described in 2.02 and 2.04,
     revising paragraph C1.                                   amended by revising the second                            only the remaining visual acuity for distance
        17. Section 7.00 is amended by                        sentence.                                                 of the better eye with best correction based
                                                                 7. Section 103.04, paragraph B3, is                    on the Snellen test chart measurement may
     adding two new sentences to paragraph
                                                                                                                        be used. * * *
     B.                                                       revised.
        18. Section 7.00 is amended by                           8. Section 103.05 is added after Table                 *       *        *       *     *
                                                              III.                                                         5. Visual efficiency. Loss of visual
     revising the first sentence of the first                                                                           efficiency may be caused by disease or injury
     paragraph of paragraph E.                                   9. Section 104.00, paragraph A, is                     resulting in reduction of visual acuity or
        19. Section 7.11 is amended by                        amended by revising the last sentence of                  visual field. The visual efficiency of one eye
     revising the heading.                                    the fifth undesignated paragraph, and                     is the product of the percentage of visual
        20. Section 7.16 is amended by                        paragraph E is amended by revising the                    acuity efficiency and the percentage of visual
     revising the heading and by revising                     first sentence of the second                              field efficiency. (See tables no. 1 and 2,
     paragraph A.                                             undesignated paragraph and adding a                       following 2.09.)
        21. Section 7.17 is amended by                        new sentence to the second                                *       *        *       *     *
     revising the heading and by revising the                 undesignated paragraph.                                       B. * * *
     first sentence.                                             10. Section 105.00 is amended by                           2. * * *
        22. Section 8.06 is amended by                        revising the first sentence in paragraph                  *       *        *       *     *
     revising the heading.                                    B and adding two new sentences.                             * * * When polytomograms, contrast
        23. Section 9.00, the first paragraph,                   11. Section 105.05 is amended by                       radiography, or other special tests have been
     is amended by adding two new                             revising paragraphs A and C.                              performed, copies of the reports of these tests
                                                                 12. Section 105.09 is added.                           should be obtained in addition to appropriate
     sentences.                                                                                                         medically acceptable imaging reports of the
        24. In section 9.02, the word ‘‘With:’’                  13. Section 107.00, paragraph C, is
                                                              amended by revising the heading and by                    skull and temporal bone. Medically
     following the heading and paragraph A                                                                              acceptable imaging includes, but is not
     are removed and the paragraph                            revising the first sentence.
                                                                                                                        limited to, x-ray imaging, computerized axial
     designation ‘‘B’’ is removed from                           14. Section 107.11 is amended by                       tomography (CAT scan) or magnetic
     paragraph B.                                             revising the heading.                                     resonance imaging (MRI), with or without
        25. Section 9.03, paragraph A, is                        15. Section 111.00 paragraph A is                      contrast material, myelography, and
     revised.                                                 revised and paragraph B is amended by                     radionuclear bone scans. ‘‘Appropriate’’
        26. Section 11.00 is amended in                       revising the heading, and by removing                     means that the technique used is the proper
                                                              the second sentence.                                      one to support the evaluation and diagnosis
     paragraph A:                                                                                                       of the impairment.
                                                                 16. Section 111.02 is amended by
        a. By revising the heading;                                                                                       3. Loss of speech. In evaluating the loss of
                                                              revising the headings of paragraphs A
        b. By revising the first sentence in                                                                            speech, the ability to produce speech by any
                                                              and B; by revising the first sentence of
     paragraph 11.00A;                                                                                                  means includes the use of mechanical or
                                                              the introductory text of paragraphs A
        c. By removing the first undesignated                                                                           electronic devices that improve voice or
                                                              and B; and by revising paragraph B3.                      articulation. Impairments of speech may also
     paragraph; and
                                                                 17. Section 111.03 is amended by                       be evaluated under the body system for the
        d. By revising the first, second and
                                                              revising the heading.                                     underlying disorder, such as neurological
     third sentences in the second                               18. Section 113.00 is amended by                       disorders, 11.00ff.
     undesignated paragraph.                                  revising the third sentence in paragraph
        27. Section 11.02 is amended by                                                                                 *       *        *       *     *
                                                              B and by adding two new sentences to                         2.04 Loss of visual efficiency. The visual
     revising the heading.                                    paragraph B.                                              efficiency of the better eye after best
        28. Section 11.03 is amended by                          19. Section 114.00 is amended by                       correction is 20 percent or less. (The percent
     revising the heading.                                    revising the first sentence of the second                 of remaining visual efficiency is equal to the
        29. Section 11.15 is removed and                      undesignated paragraph of paragraph B                     product of the percent of remaining visual
     reserved.                                                and by adding two new sentences                           acuity efficiency and the percent of
        30. Section 11.17 is amended by                       following this sentence.                                  remaining visual field efficiency.)
     revising paragraph A.                                                                                                 2.05 [Reserved.]
                                                                 20. Section 114.08 is amended by
        31. Section 13.08 is revised.                         revising paragraph N6.                                    *       *        *       *     *
        32. Section 14.00 is amended by                          The added and revised text is as                         2.09 Loss of speech due to any cause,
     revising the first sentence of the first                 follows:                                                  with inability to produce by any means
     undesignated paragraph of paragraph B                                                                              speech that can be heard, understood, or
     and by adding two new sentences                          Appendix 1 to Subpart P of Part 404–                      sustained.
     following this sentence.                                 Listing of Impairments                                    *       *        *       *     *
        33. Section 14.08 is amended by                       *      *         *       *       *                        3.00    Respiratory System
     revising paragraph M6.
                                                              2.00   Special Senses and Speech                          *       *        *       *     *
        B. In part B:                                                                                                     E. Documentation of pulmonary function
        1. Section 100.00, paragraph B, is                    A. Disorders of Vision                                    testing.
     revised.                                                    1. Causes of impairment. Diseases or injury            *       *        *       *     *
        2. Section 102.00 is amended by                       of the eyes may produce loss of visual acuity               * * * If the spirogram was generated by
     revising the first and second sentences                  or loss of the peripheral field. Loss of visual           any means other than direct pen linkage to
     of paragraph A.                                          acuity results in inability to distinguish                a mechanical displacement-type spirometer,
        3. Section 102.02 is amended by                       detail and prevents reading and fine work.                the testing device must have had a recorded
     revising the heading.                                    Loss of the peripheral field restricts the                calibration performed previously on the day
        4. Section 103.00, paragraph B, is                    ability of an individual to move about freely.            of the spirometric measurement.
                                                              The extent of impairment of sight should be
     amended by revising the last sentence of                 determined by visual acuity and peripheral                *       *        *       *     *
     the second undesignated paragraph.                       field testing.                                              F. Documentation of chronic impairment
        5. Section 103.00, paragraph D, is                       2. Visual acuity. Loss of visual acuity may            of gas exchange.
     amended by adding a new first                            result in impaired distant vision or near                   1. * * *
     undesignated paragraph.                                  vision, or both. However, for you to meet the             *       *        *       *     *


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     20026            Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations

       * * * The percentage concentrations of                  C. Recurrent obstruction demonstrated by                8.06 Hidradenitis suppurativa, acne
     inspired O2 and inspired and expired CO and             endoscopy or other appropriate medically                conglobata.
     He for each of the maneuvers should be                  acceptable imaging; or,                                 *        *      *       *     *
     provided. Sufficient data must be provided,             *       *      *       *       *
     including documentation of the source of the                                                                    9.00 Endocrine System
                                                               5.05 Chronic liver disease (e.g., portal,
     predicted equation, to permit verification              postnecrotic, or biliary cirrhosis; chronic               * * * Medically acceptable imaging
     that the test was performed adequately, and             active hepatitis; Wilson’s disease). With:              includes, but is not limited to, x-ray imaging,
     that, if necessary, corrections for anemia or             A. Esophageal varices (demonstrated by                computerized axial tomography (CAT scan)
     carboxyhemoglobin were made                             endoscopy or other appropriate medically                or magnetic resonance imaging (MRI), with or
     appropriately.                                          acceptable imaging) with a documented                   without contrast material, myelography, and
                                                             history of massive hemorrhage attributable to           radionuclear bone scans. ‘‘Appropriate’’
     *      *     *       *      *                                                                                   means that the technique used is the proper
                                                             these varices. * * *
       3.11 Lung transplant. Consider under a                                                                        one to support the evaluation and diagnosis
     disability for 12 months following the date of          *       *      *       *       *                        of the impairment.
     surgery; thereafter, evaluate the residual                5.09 Liver transplant. Consider under a
                                                             disability for 12 months following the date of          *        *      *       *     *
     impairment.                                                                                                       9.03 Hyperparathyroidism. With:
                                                             surgery; thereafter, evaluate the residual
     4.00   Cardiovascular System                            impairment(s).                                            A. Generalized decalcification of bone on
                                                                                                                     appropriate medically acceptable imaging
       A.* * *                                               6.00 Genito-Urinary System                              study and elevation of plasma calcium to 11
       * * * Therefore, in any case in which you                                                                     mg. per deciliter (100 ml.) or greater; or
                                                               A. * * * Medically acceptable imaging
     have a medically determinable impairment
                                                             includes, but is not limited to, x-ray imaging,         *        *      *       *     *
     that is not listed, or a combination of                 computerized axial tomography (CAT scan)                   11.00 Neurological
     impairments no one of which meets a listing,            or magnetic resonance imaging (MRI), with or               A. Epilepsy. In epilepsy, regardless of
     we will consider a medical equivalence                  without contrast material, myelography, and             etiology, degree of impairment will be
     determination. * * *                                    radionuclear bone scans. ‘‘Appropriate’’                determined according to type, frequency,
     *      *     *       *      *                           means that the technique used is the proper             duration, and sequelae of seizures. * * *
        C. * * *                                             one to support the evaluation and diagnosis                Under 11.02 and 11.03, the criteria can be
        3. * * * In selected cases, these tests may          of the impairment.                                      applied only if the impairment persists
     be purchased after a medical history and                *       *      *       *       *                        despite the fact that the individual is
     physical examination, report of appropriate                 6.02    * * *                                       following prescribed antiepileptic treatment.
     medically acceptable imaging, ECGs, and                                                                         Adherence to prescribed antiepileptic
                                                             *       *      *       *       *                        therapy can ordinarily be determined from
     other appropriate tests have been evaluated,               C. * * *
     preferably by a program physician with                                                                          objective clinical findings in the report of the
                                                                1. Renal osteodystrophy manifested by                physician currently providing treatment for
     experience in the care of patients with                 severe bone pain and abnormalities shown by
     cardiovascular disease. Medically acceptable                                                                    epilepsy. Determination of blood levels of
                                                             appropriate medically acceptable imaging                phenytoin sodium or other antiepileptic
     imaging includes, but is not limited to, x-ray          (e.g., osteitis fibrosa, marked osteoporosis,
     imaging, computerized axial tomography                                                                          drugs may serve to indicate whether the
                                                             pathologic fractures); or                               prescribed medication is being taken. * * *
     (CAT scan) or magnetic resonance imaging
                                                             *       *      *       *       *                        *        *      *       *     *
     (MRI), with or without contrast material,
     myelography, and radionuclear bone scans.               7.00     Hemic and Lymphatic System                        11.02 Epilepsy—convulsive epilepsy,
     ‘‘Appropriate’’ means that the technique used                                                                   (grand mal or psychomotor), documented by
                                                             *       *      *       *       *                        detailed description of a typical seizure
     is the proper one to support the evaluation               B. * * * Medically acceptable imaging
     and diagnosis of the impairment. * * *                                                                          pattern, including all associated phenomena;
                                                             includes, but is not limited to, x-ray imaging,         occurring more frequently than once a month
     *      *     *       *      *                           computerized axial tomography (CAT scan)                in spite of at least 3 months of prescribed
                                                             or magnetic resonance imaging (MRI), with or            treatment.
     5.00   Digestive System                                 without contrast material, myelography, and
     *      *     *       *      *                           radionuclear bone scans. ‘‘Appropriate’’                *        *      *       *     *
                                                             means that the technique used is the proper                11.03 Epilepsy—nonconvulsive epilepsy
       C. * * * To be considered a severe
                                                             one to support the evaluation and diagnosis             (petit mal, psychomotor, or focal),
     impairment which will last for at least 12
                                                             of the impairment.                                      documented by detailed description of a
     months, a recurrent ulcer after definitive
                                                                                                                     typical seizure pattern, including all
     surgery must be demonstrated, despite                   *       *      *       *       *                        associated phenomena; occurring more
     therapy, by repeated appropriate medically                E. Acute leukemia (including T-cell                   frequently than once weekly in spite of at
     acceptable imaging of the upper                         lymphoblastic lymphoma). Initial diagnosis              least 3 months of prescribed treatment.
     gastrointestinal tract or by gastroscopic               of acute leukemia or T-cell lymphoblastic
     examinations. Medically acceptable imaging              lymphoma must be based upon definitive                  *        *      *       *     *
                                                             bone marrow pathologic evidence. * * *                      11.15     [Reserved.]
     includes, but is not limited to, x-ray imaging,
     computerized axial tomography (CAT scan)                *       *      *       *       *                        *        *      *       *     *
     or magnetic resonance imaging (MRI), with or              7.11 Acute leukemia (including T-cell                   11.17 Degenerative disease not listed
     without contrast material, myelography, and             lymphoblastic lymphoma).                                elsewhere, such as Huntington’s chorea,
     radionuclear bone scans. ‘‘Appropriate’’                                                                        Friedreich’s ataxia, and spino-cerebellar
                                                             *       *      *       *       *                        degeneration. With:
     means that the technique used is the proper               7.16 Multiple myeloma (confirmed by
     one to support the evaluation and diagnosis                                                                       A. Disorganization of motor function as
                                                             appropriate serum or urine protein                      described in 11.04B; or * * *
     of the impairment. * * *                                electrophoresis and bone marrow findings).
     *      *     *       *      *                           With:
                                                                                                                     *        *      *       *     *
                                                                                                                       13.08 Thyroid gland:
        5.03 Stricture, stenosis, or obstruction of            A. Appropriate medically acceptable
                                                                                                                       A. Anaplastic (undifferentiated) carcinoma
     the esophagus (demonstrated by endoscopy                imaging evidence of bony involvement with
                                                                                                                     of the thyroid; or
     or other appropriate medically acceptable               intractable bone pain; or
                                                                                                                       B. Carcinoma with metastases beyond the
     imaging) with weight loss as described under            *       *      *       *       *                        regional lymph nodes, not controlled by
     listing 5.08.                                             7.17 Aplastic anemias or hematologic                  prescribed therapy.
        5.04 Peptic ulcer disease (demonstrated              malignancies (excluding acute leukemia and
     by endoscopy or other appropriate medically
                                                                                                                     *        *      *       *     *
                                                             T-cell lymphoblastic lymphoma): With bone
     acceptable imaging).                                    marrow or stem cell transplantation. * * *              14.00        Immune System
     *      *     *       *      *                           *       *      *       *       *                        *        *      *       *     *


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                           Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations                                                     20027

       B. * * *                                                   calibration performed previously on the day                one to support the evaluation and diagnosis
       The documentation needed to establish the                  of the spirometric measurement.                            of the impairment. * * *
     existence of a connective tissue disorder is                 *       *         *       *       *                        *       *        *       *     *
     medical history, physical examination,                          D. * * *                                                  105.05 Chronic liver disease. * * *
     selected laboratory studies, appropriate                                                                                  A. Inoperable biliary atresia demonstrated
                                                                     Medically acceptable imaging includes, but
     medically acceptable imaging, and, in some                                                                              by appropriate medically acceptable imaging
                                                                  is not limited to, x-ray imaging,
     instances, tissue biopsy. Medically                                                                                     or surgery; or
                                                                  computerized axial tomography (CAT scan)
     acceptable imaging includes, but is not
     limited to, x-ray imaging, computerized axial                or magnetic resonance imaging (MRI), with or               *       *        *       *     *
     tomography (CAT scan) or magnetic                            without contrast material, myelography, and                  C. Esophageal varices (demonstrated by
     resonance imaging (MRI), with or without                     radionuclear bone scans. ‘‘Appropriate’’                   endoscopy or other appropriate medically
     contrast material, myelography, and                          means that the technique used is the proper                acceptable imaging); or
     radionuclear bone scans. ‘‘Appropriate’’                     one to support the evaluation and diagnosis                *       *        *       *     *
     means that the technique used is the proper                  of the impairment.                                           105.09 Liver transplant. Consider under a
     one to support the evaluation and diagnosis                     E. * * *                                                disability for 12 months following the date of
     of the impairment. * * *                                        The diagnosis is established by the                     surgery; thereafter, evaluate the residual
                                                                  requirement for continuous or nocturnal                    impairment.
     *      *         *       *       *
                                                                  supplemental oxygen for more than 30 days,
       14.08 Human immunodeficiency virus                                                                                    *       *        *       *     *
     (HIV) infection.                                             in association with characteristic changes on
                                                                  medically acceptable imaging and clinical                  107.00      Hemic and Lymphatic System
     *      *         *       *       *                           signs of respiratory dysfunction, including
      M. * * *                                                                                                               *       *        *       *     *
                                                                  retractions, rales, wheezing, and tachypnea.                 C. Acute leukemia (including T-cell
      6. Sinusitis documented by appropriate
                                                                  *       *         *       *       *                        lymphoblastic lymphoma). Initial diagnosis
     medically acceptable imaging.
                                                                       103.04 Cystic fibrosis.                               of acute leukemia or T-cell lymphoblastic
     *      *         *       *       *                                                                                      lymphoma must be based upon definitive
                                                                  *       *         *       *       *                        bone marrow pathologic evidence. * * *
     100.00     Growth Impairment                                   B. * * *
     *      *         *       *       *                             3. Appropriate medically acceptable                      *       *        *       *     *
        B. Bone age determinations should include                 imaging evidence of extensive disease, such                  107.11 Acute leukemia (including T-cell
     a full descriptive report of medically                       as thickening of the proximal bronchial                    lymphoblastic lymphoma).
     acceptable imaging specifically obtained to                  airways or persistence of bilateral                        *       *        *       *     *
     determine bone age and must cite the                         peribronchial infiltrates;
                                                                                                                             111.00 Neurological
     standardization method used. Where                           *       *         *       *       *
     appropriate medically acceptable imaging                       103.05 Lung transplant. Consider under a                   A. Convulsive epilepsy must be
     must be obtained currently as a basis for                                                                               substantiated by at least one detailed
                                                                  disability for 12 months following the date of
     adjudication under 100.03, views or scans of                                                                            description of a typical seizure. Report of
                                                                  surgery; thereafter, evaluate the residual
     the left hand and wrist should be ordered. In                                                                           recent documentation should include a
                                                                  impairment(s).
     addition appropriate medically acceptable                                                                               neurological examination with frequency of
     imaging of the knee and ankle should be                      104.00      Cardiovascular System                          episodes and any associated phenomena
     obtained when cessation of growth is being                      A. * * *                                                substantiated.
     evaluated in an older child at, or past,                        When you have a medically determinable                    Young children may have convulsions in
     puberty. Medically acceptable imaging                        impairment that is not listed, an impairment               association with febrile illnesses. Proper use
     includes, but is not limited to, x-ray imaging,              that does not meet the requirements of a                   of 111.02 and 111.03 requires that epilepsy
     computerized axial tomography (CAT scan)                     listing, or a combination of impairments no                be established. Although this does not
     or magnetic resonance imaging (MRI), with or                                                                            exclude consideration of seizures occurring
                                                                  one of which meets the requirements of a
     without contrast material, myeolgraphy, and                                                                             during febrile illnesses, it does require
                                                                  listing, we will consider a determination
     radionuclear bone scans. ‘‘Appropriate’’                                                                                documentation of seizures during nonfebrile
                                                                  whether your impairment(s) medically equals
     means that the technique used is the proper                                                                             periods.
                                                                  or, as appropriate, functionally equals the
     one to support the evaluation and diagnosis                                                                               There is an expected delay in control of
                                                                  listings. (See §§ 404.1526, 416.926, and
     of the impairment.                                                                                                      epilepsy when treatment is started,
                                                                  416.926a.)
                                                                                                                             particularly when changes in the treatment
     *      *         *       *       *                           *       *         *       *       *                        regimen are necessary. Therefore, an
     102.00 Special Senses and Speech                               E. * * *                                                 epileptic disorder should not be considered
                                                                    Findings of cardiomegaly shown by                        to meet the requirements of 111.02 or 111.03
       A. Visual impairments in children.                         appropriate medically acceptable imaging                   unless it is shown that convulsive episodes
     Impairment of visual acuity should be
                                                                  evidence must be accompanied by other                      have persisted more than three months after
     determined with use of the standard Snellen
                                                                  evidence of chronic heart failure or                       prescribed therapy began.
     test chart. Where this cannot be used, as in
                                                                  ventricular dysfunction. ‘‘Appropriate’’                     B. Nonconvulsive epilepsy. * * *
     very young children, a complete description
                                                                  means that the imaging technique used is the               *       *        *       *     *
     of the findings should be provided, using
                                                                  proper one to support the evaluation and                     111.02 Major motor seizure disorder.
     other appropriate methods of examination,
                                                                  diagnosis of the impairment. * * *                           A. Convulsive epilepsy. In a child with an
     along with a description of the techniques
     used for determining the visual acuity for                   *       *         *       *       *                        established diagnosis of epilepsy, the
     distance. * * *                                                                                                         occurrence of more than one major motor
                                                                  105.00      Digestive System
                                                                                                                             seizure per month despite at least three
     *      *         *       *       *                           *       *         *       *       *                        months of prescribed treatment. * * *
         102.02 Impairments of visual acuity.                       B. Documentation of gastrointestinal
     *      *         *       *       *                                                                                      *       *        *       *     *
                                                                  impairments should include pertinent                          B. Convulsive epilepsy syndrome. In a
     103.00     Respiratory System                                operative findings, appropriate medically                  child with an established diagnosis of
                                                                  acceptable imaging studies, endoscopy, and                 epilepsy, the occurrence of at least one major
     *      *         *       *       *                           biopsy reports. Medically acceptable imaging
         B. * * *                                                                                                            motor seizure in the year prior to application
                                                                  includes, but is not limited to, x-ray imaging,            despite at least three months of prescribed
     *      *         *       *       *                           computerized axial tomography (CAT scan)                   treatment. * * *
       * * * If the spirogram was generated by                    or magnetic resonance imaging (MRI), with or
     any means other than direct pen linkage to                   without contrast material, myelography, and                *       *        *       *     *
     a mechanical displacement-type spirometer,                   radionuclear bone scans. ‘‘Appropriate’’                       3. Significant mental disorder; or
     the testing device must have had a recorded                  means that the technique used is the proper                *       *        *       *     *


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     20028                 Federal Register / Vol. 67, No. 79 / Wednesday, April 24, 2002 / Rules and Regulations

         111.03     Nonconvulsive epilepsy. * * *                 regulatory impediments to the                         part 1) and the Procedure and
     *      *         *       *       *                           electronic filing of Form 1040, ‘‘U.S.                Administration Regulations (26 CFR
                                                                  Individual Income Tax Return.’’ These                 part 301) designed to eliminate
     113.00     Neoplastic Diseases, Malignant
                                                                  regulations generally affect taxpayers                regulatory impediments to the
     *      *         *       *       *                           who file Form 1040 electronically and                 electronic filing of Form 1040.
        B. Documentation. * * * If an operative
     procedure has been performed, the evidence
                                                                  who are required to file any of the                      In 1998, Congress enacted the Internal
     should include a copy of the operative note                  following forms: Form 56, ‘‘Notice                    Revenue Service Restructuring and
     and the report of the gross and microscopic                  Concerning Fiduciary Relationship’’;                  Reform Act of 1998 (RRA 1998), Public
     examination of the surgical specimen, along                  Form 2120, ‘‘Multiple Support                         Law 105–206 (112 Stat. 685) (1998).
     with all pertinent laboratory reports or                     Declaration’’; Form 2439, ‘‘Notice to                 Section 2001(a) of RRA 1998 states that
     reports from appropriate medically                           Shareholder of Undistributed Long-                    the policy of Congress is that paperless
     acceptable imaging. Medically acceptable                     Term Capital Gains’’; Form 3468,                      filing should be the preferred and most
     imaging includes, but is not limited to, x-ray               ‘‘Investment Credit’’; and Form T                     convenient means of filing Federal tax
     imaging, computerized axial tomography
     (CAT scan) or magnetic resonance imaging
                                                                  (Timber), ‘‘Forest Activities Schedules.’’            returns. Section 2001(a) of RRA 1998
     (MRI), with or without contrast material,                    The text of the temporary regulations                 also sets a long-range goal for the IRS to
     myelography, and radionuclear bone scans.                    also serves as the text of the proposed               have at least 80 percent of all Federal
     ‘‘Appropriate’’ means that the technique used                regulations set forth in the notice of                tax returns filed electronically by 2007.
     is the proper one to support the evaluation                  proposed rulemaking on this subject in                Section 2001(b) of RRA 1998 requires
     and diagnosis of the impairment. * * *                       the Proposed Rules section in this issue              the IRS to establish a 10-year strategic
     *      *         *       *       *                           of the Federal Register.                              plan to eliminate barriers to electronic
     114.00     Immune System                                     EFFECTIVE DATE: These regulations are                 filing. To the extent practicable, this
                                                                  effective April 24, 2002.                             plan is to provide for electronic filing of
     *      *         *       *       *
         B. * * *                                                 FOR FURTHER INFORMATION CONTACT:                      electronically prepared returns for
                                                                  James C. Gibbons, (202) 622–4910 (not                 taxable years beginning after 2001.
     *      *         *       *       *                                                                                    The temporary regulations amend the
       The documentation needed to establish the                  a toll-free number).
     existence of a connective tissue disorder is                 SUPPLEMENTARY INFORMATION:                            Procedure and Administration
     medical history, physical examination,                                                                             Regulations to provide a regulatory
     selected laboratory studies, appropriate
                                                                  Paperwork Reduction Act                               statement of IRS authority to prescribe
     medically acceptable imaging, and, in some                     These regulations are being issued                  what return information or
     instances, tissue biopsy. Medically                          without prior notice and public                       documentation must be filed with a
     acceptable imaging includes, but is not                      procedure pursuant to the                             return, statement or other document
     limited to, x-ray imaging, computerized axial                Administrative Procedure Act (5 U.S.C.                required to be made under any
     tomography (CAT scan) or magnetic
     resonance imaging (MRI), with or without
                                                                  553). For this reason, the collections of             provision of the internal revenue laws
     contrast material, myelography, and                          information contained in these                        or regulations. The regulations give the
     radionuclear bone scans. ‘‘Appropriate’’                     regulations have been reviewed and,                   IRS maximum flexibility in prescribing
     means that the technique used is the proper                  pending receipt and evaluation of                     (1) what needs to be filed in support of
     one to support the evaluation and diagnosis                  public comments, approved by the                      a return or claim, and (2) the form of the
     of the impairment. * * *                                     Office of Management and Budget under                 filing, e.g., electronic versus paper. The
     *      *         *       *       *                           control number 1545–1783. Responses                   regulations permit the IRS to prescribe
       114.08 Human immunodeficiency virus                        to these collections of information are               required return information in forms,
     (HIV) infection.                                             mandatory.                                            instructions, or other appropriate
     *      *         *       *       *                             An agency may not conduct or                        guidance.
      N. * * *                                                    sponsor, and a person is not required to                 In addition, the IRS identified five
      6. Sinusitis documented by appropriate                      respond to, a collection of information               regulatory provisions that impede
     medically acceptable imaging.                                unless the collection of information                  electronic filing by requiring the
     *      *         *       *       *                           displays a valid OMB control number.                  taxpayer to either include a third-party
                                                                    For further information concerning                  signature, or attach a document
     [FR Doc. 02–9737 Filed 4–23–02; 8:45 am]                     these collections of information, and                 generated by a third party. The
     BILLING CODE 4191–02–P                                       where to submit comments on the                       temporary regulations amend those
                                                                  collections of information and the                    provisions to eliminate the
                                                                  accuracy of the estimated burden, and                 impediments.
     DEPARTMENT OF THE TREASURY                                   suggestions for reducing this burden,                    Although the regulatory impediments
                                                                  please refer to the preamble to the cross-            to the electronic filing of Form 1040 are
     Internal Revenue Service                                     referencing notice of proposed                        eliminated by the temporary
                                                                  rulemaking published in the Proposed                  regulations, the IRS may instruct a
     26 CFR Parts 1, 301 and 602                                  Rules section of this issue of the Federal            taxpayer who files Form 1040 on paper
     [TD 8989]                                                    Register.                                             to attach a document that would not be
                                                                    Books or records relating to a                      required in the case of a Form 1040 filed
     RIN 1545–AY56                                                collection of information must be                     electronically.
                                                                  retained as long as their contents may
     Guidance Necessary To Facilitate                                                                                   Explanation of Provisions
                                                                  become material in the administration
     Electronic Tax Administration
                                                                  of any internal revenue law. Generally,               1. General Provision
     AGENCY:  Internal Revenue Service (IRS),                     tax returns and tax return information
     Treasury.                                                    are confidential, as required by 26                     Section 6001(a) of the Internal
     ACTION: Final and temporary                                  U.S.C. 6103.                                          Revenue Code (Code) provides that
     regulations.                                                                                                       every person liable for any tax, or for the
                                                                  Background                                            collection thereof, will keep such
     SUMMARY: This document contains                                This document contains amendments                   records, render such statements, make
     regulations designed to eliminate                            to the Income Tax Regulations (26 CFR                 such returns, and comply with such


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