Endocrine Disorders Listing Undergoing Revision

January 21, 2010

Author: Catherine M. Callery (Kate)| Louise M. Tarantino

In August 2005, SSA asked for input on how to revise its Listing of Impairments. In a December 14, 2009 notice, SSA proposes some radical changes to the Endocrine Listing for adults and children, Listings 9 and 109. 74 Fed. Reg. Fed. Reg. 66069. Listings criteria 9.01 - 9.08 are gone, “revised” out of existence. Children fare only slightly better, with children up to age 6 who require daily supervision to administer insulin meeting the Listing at 109.08.

SSA’s last major revision of the endocrine disorders Listing was published December 6, 1985, with amendments August 24, 1999, and April 24, 2002. However, “Since 1985, medical science has made significant advances in detecting endocrine disorders at earlier stages, and newer treatments have resulted in better management of these conditions. . . .”

According to SSA, “Many of the current listings in the endocrine system are “reference listings”--listings that are met by satisfying the criteria of other listings. Endocrine glands regulate the functioning of organs and other glands, and endocrine disorders can cause problems that are of listing-level severity and that meet the duration requirement when they affect those organs or other glands.  We evaluate these effects  under other body system listings. . . .”

Parts 9 & 109 of the Listings are not themselves removed. The introductory and explanatory sections are retained in this proposed regulatory change, with revised language. One might ask of SSA, “Why are we proposing to include guidance for evaluating endocrine disorders in sections 9.00 and 109.00 when there would be no endocrine disorders listings other than proposed listing 109.08?”

The answer: “As we explain in the proposed sections 9.00C and 109.00D, endocrine-related impairments that do not meet or medically equal any listing may nonetheless result in a finding of disability for both adults and children. We may find adults to be disabled based on their residual functional capacity, age, education, and work experience. Sections 404.1520(g) and 416.920(g).  We may find children who apply for SSI benefits to be disabled based on impairments that functionally equal the listings. Sections 416.924(d) and 416.926a.”

In other words, this may be just another step SSA is taking along the path toward applying functional analysis in the Listings instead of medical findings.

SSA also notes that “[I]f these rules become final, we will not terminate any person's disability benefits solely because we have removed any endocrine disorder listing, nor will we review prior allowances based on the endocrine disorders listings under the new rules.  Unless we are otherwise required to do so (for example, by statute), we do not readjudicate previously decided cases when we revise our listings.  We must periodically conduct continuing disability reviews to determine whether beneficiaries are still disabled. Sections 404.1589 and 416.989.  When we do, we will not find that a person’s disability has ended based on a change in a listing. In most cases, we must show that the person's impairment(s) has medically improved and that any medical improvement is “related to the ability to work.”  Sections 404.1594 and 416.994.  Even where the impairment(s) has medically improved, our regulations provide that the improvement is not “related to the ability to work” if it continues to meet or medically equal the “same listing section used to make our most recent favorable decision.”  This is true even if we have   deleted the listing section we used to make the most recent favorable decision. Sections 404.1594(c)(3)(i) and 416.994(b)(2)(iv)(A).  When we find that medical improvement is not related to the ability to work (or, in the case of a person under age 18, the impairment still meets or medically equals the prior listing), we will find that disability continues, unless an exception to medical improvement applies.”

Comments to the proposed Listing change are due by February 12, 2010.