SSR 91-7c: SECTION 1614(a)(3)(A) OF THE SOCIAL SECURITY ACT (42 U.S.C. 1382c(a)(3)(A)) SUPPLEMENTAL SECURITY INCOME -- DISABILITY STANDARDS FOR CHILDREN

SSR 91-7c

EFFECTIVE/PUBLICATION DATE: 8/1/91

20 CFR 416.924 and 416.994(c)

Sullivan v. Zebley, 110 S.Ct. 885 (1990)

(The following Social Security Rulings (SSR) have been rescinded: SSR

83-19, Cumulative Edition (C.E.) 1981-1985, p. 370 and SSR 85-21c, C.E.

1981-1985, p. 818. This Ruling supersedes SSR 82-52, C.E. 1981-1985, p.

328, SSR 82-53, C.E. 1981-1985, p. 312, and SSR 86-8 , C.E. 1986, p. 78

to the extent these SSRs discuss the former procedures used to determine

disability in children.)

BLACKMUN, Supreme Court Justice:

This case concerns a facial challenge to the method used by the Secretary

of Health and Human Services to determine whether a child is "disabled,"

and therefore eligible for benefits under the Supplemental Security Income

Program, Title XVI of the Social Security Act, as added, 86 Stat. 1465,

and amended, 42 U.S.C. § 1381 et seq. (1982 ed. and Supp. V).

I

In 1972, Congress enacted the Supplemental Security Income Program (SSI)

to assist "individuals who have attained age 65 or are blind or disabled"

by setting a guaranteed minimum income level for such persons. 42 U.S.C. §

1381. The program went into effect January 1, 1974. Currently, about

2,000,000 claims for SSI benefits are adjudicated each year. Of these,

about 100,000 are child-disability

claims. [1]

A person is eligible for SSI benefits if his income and financial

resources are below a certain level, § 1382(a) and if he is "disabled."

Disability is defined in § 1382c(a)(3) as follows:

This statutory definition of disability was taken from Title II of the

Social Security Act, 42 U.S.C. § 423 et seq. , as amended (providing

for payment of insurance benefits to disabled workers who have contributed

to the Social Security Program). See § 423(d)(1)(A) and (d)(2)(A)

(definitions of disability).

(a) and if he is "disabled."

Disability is defined in § 1382c(a)(3) as follows:

This statutory definition of disability was taken from Title II of the

Social Security Act, 42 U.S.C. § 423 et seq. , as amended (providing

for payment of insurance benefits to disabled workers who have contributed

to the Social Security Program). See § 423(d)(1)(A) and (d)(2)(A)

(definitions of disability).

Pursuant to his statutory authority to implement the SSI

Program, [2] the Secretary has

promulgated regulations creating a 5-step test to determine whether an adult claimant is disabled. See Bowen v. Yuckert , 482 U.S.

137, 140-142, 107 S.Ct. 2287, 2290-91, 96 L.Ed.2d 119

(1987). [3] The first two steps

involve threshold determinations that the claimant is not presently

working, and has an impairment which is of the required duration and which

significantly limits his ability to work. See 20 CFR §§ 416.920(a) through

(c) (1989). In the third step, the medical evidence of the claimant's

impairment is compared to a list of impairments presumed severe enough to

preclude any gainful work. See 20 CFR pt. 404, subpt. P, App. 1 (pt. A)

(1989). If the claimant's impairment matches or is "equal" to one of the

listed impairments, he qualified for benefits without further inquiry. §

416.920(d). If the claimant cannot qualify under the listings, the

analysis proceeds to the fourth and fifth steps. At these steps, the

inquiry is whether the claimant can do his own past work or any other work

that exists in the national economy, in view of his age, education, and

work experience. If the claimant cannot do his past work or other work, he

qualified for benefits. §§ 416.920(e) and (f).

the claimant cannot qualify under the listings, the

analysis proceeds to the fourth and fifth steps. At these steps, the

inquiry is whether the claimant can do his own past work or any other work

that exists in the national economy, in view of his age, education, and

work experience. If the claimant cannot do his past work or other work, he

qualified for benefits. §§ 416.920(e) and (f).

The Secretary's test for determining whether a child claimant is

disabled is an abbreviated version of the adult test. A child qualified

for benefits if he "is not doing any substantial gainful activity," §

416.924(a), if his impairment meets the duration requirement, §

416.924(b)(1), and if it matches or is medically equal to a listed

impairment, §§ 416.924(b)(2) and (3). In evaluating a child's claim, both

the general listings and a special listing of children's impairments, 20

CFR pt. 404, subpt P, App. 1 (pt. B) are considered. If a child cannot

qualify under these listings, he is denied benefits. There is no further

inquiry corresponding to the fourth and fifth steps of the adult test.

II

Respondent Brian Zebley, a child who had been denied SSI benefits,

brought a class action in the United States District Court for the Eastern

District of Pennsylvania to challenge the child-disability

regulations. [4] His complaint

alleges that the Secretary

Complaint in ED Pa. Civil Action No. 83-3314, ¶ 2. The District Court, on

January 10, 1984, certified a class of all persons "who are now, or who in

the future will be, entitled to an administrative determination . . . as

to whether supplemental security income benefits are payable on account of

a child who is disabled, or as to whether such benefits have been

improperly denied, or improperly terminated, or should be resumed."

3314, ¶ 2. The District Court, on

January 10, 1984, certified a class of all persons "who are now, or who in

the future will be, entitled to an administrative determination . . . as

to whether supplemental security income benefits are payable on account of

a child who is disabled, or as to whether such benefits have been

improperly denied, or improperly terminated, or should be resumed."

The court in due course granted summary judgment in the Secretary's favor

as to the class claims, ruling that the regulations are not "facially

invalid or incomplete . . . and permi[t] the award of benefits in

conformity with the intent of Congress." Zebley v. Heckler, 642 F.

Supp. 220, 222 (1986). The Court of Appeals for the Third Circuit vacated

in part that summary judgment. Zebley ex rel. Zebley v. Bowen, 855

F.2d 67 (1988). The Third Circuit found the Secretary's regulatory scheme

for child disability benefits inconsistent with the statute, because the

listings-only approach of the regulations does not account for all

impairments of "comparable severity," and denies child claimants the

individualized functional assessment that the statutory standard requires

and that the Secretary provides to adults. Id. , at 69. Although the

Court of Appeals recognized that the Secretary's interpretation of the

statute is entitled to deference, it rejected the regulations as contrary

to clear congressional intent. The court remanded the case to the District

Court with the direction that summary judgment be entered in favor of the

plaintiff class on the claim that the Secretary must give child claimants

an opportunity for individualized assessment of their functional

limitations. Id. , at 77. We granted certiorari to resolve a

conflict among the Circuits as to the validity of the Secretary's approach

to child disability. [5]

III

District

Court with the direction that summary judgment be entered in favor of the

plaintiff class on the claim that the Secretary must give child claimants

an opportunity for individualized assessment of their functional

limitations. Id. , at 77. We granted certiorari to resolve a

conflict among the Circuits as to the validity of the Secretary's approach

to child disability. [5]

III

Since the Social Security Act expressly grants the Secretary rulemaking

power, see n. 2, supra , "'our review is limited to determining

whether the regulations promulgated exceeded the Secretary's statutory

authority and whether they are arbitrary and capricious.'" Bowen v.

Yuckert , 482 U.S., at 145, 107 S.Ct., at 2293 (quoting Heckler v.

Campbell , 461 U.S. 458, 466, 103 S.Ct. 1952, 1957, 76 L.Ed.2d 66

(1983)); see Chevron U.S.A., Inc. v. Natural Resources Defense Council,

Inc. , 467 U.S. 837, 843-844, 104 S.Ct. 2778, 2782, 81 L.Ed.2d 694

(1984) ("If Congress has explicitly left a gap for the agency to fill,

there is an express delegation of authority to the agency to elucidate a

specific provision of the statute by regulation. Such legislative

regulations are given controlling weight unless they are arbitrary,

capricious, or manifestly contrary to the statute"). We conclude, however,

that the Secretary's child-disability regulations cannot be reconciled

with the statute they purport to implement.

The statute generally defines "disability" in terms of an individualized,

functional inquiry into the effect of medical problems on a person's

ability to work. Yukert , 482 U.S. at 146, 107 S.Ct. at 2293 (Social

Security Act adopts "functional approach"); Campbell , 461 U.S., at

459-460, 467, 103 S.Ct., at 1953, 1957 (Act "defines 'disability' in terms

of the effect a physical or mental impairment has on a person's ability to

function in the workplace; "statutory scheme contemplates that disability

hearings will be individualized determinations").

ert , 482 U.S. at 146, 107 S.Ct. at 2293 (Social

Security Act adopts "functional approach"); Campbell , 461 U.S., at

459-460, 467, 103 S.Ct., at 1953, 1957 (Act "defines 'disability' in terms

of the effect a physical or mental impairment has on a person's ability to

function in the workplace; "statutory scheme contemplates that disability

hearings will be individualized determinations").

The statutory, standard for child disability is explicitly linked to this

functional, individualized standard for adult disability. A child is

considered to be disabled "if he suffers from any . . . impairment of

comparable severity" to one that would render an adult "unable to engage

in any substantial gainful activity." 42 U.S.C. § 1382c(a)(3)(A). The next

paragraph of the statute elaborates on the adult disability standard,

providing that an adult is considered unable to engage in substantial

gainful activity, and is therefore disabled, if he is unable to do either

his own past work or other work. § 1382c(a)(3)(B). In plain words, the two

provisions together mean that a child is entitled to benefits if his

impairment is as severe as one that would prevent an adult from

working.

The question presented is whether the Secretary's method of determining

child disability conforms to this statutory standard. Respondents argue,

and the Third Circuit agreed, that it does not, because the regulatory

requirement that a child claimant's impairment must match or be equivalent

to a listed impairment denies benefits to those children whose impairments

are severe and disabling even though the impairments are not listed and

cannot meaningfully be compared with the listings

to this statutory standard. Respondents argue,

and the Third Circuit agreed, that it does not, because the regulatory

requirement that a child claimant's impairment must match or be equivalent

to a listed impairment denies benefits to those children whose impairments

are severe and disabling even though the impairments are not listed and

cannot meaningfully be compared with the listings. The Secretary concedes

that his listings do not cover every impairment that could qualify a child

for benefits under the statutory standard, but insists that the listings,

together with the equivalence determination, see 20 CFR § 416.924(b)(3),

are sufficient to carry out the statutory mandate that children with

impairments of "comparable severity" shall be considered disabled. To

decide this question, we must take a closer look at the regulations at

issue.

IV

The listings set out at 20 CFR pt. 404, subpt. P, App. I (pt. A), are

descriptions of various physical and mental illnesses and abnormalities,

most of which are categorized by the body system they

affect. [6] Each impairment is

defined in terms of several specific medical signs, symptoms, or

laboratory test results. [7] For

a claimant to show that his impairment matches a listing, it must meet all of the specified medical criteria. An impairment that manifests

only some of those criteria, no matter how severely, does not

qualify. [8] See Social Security

Ruling (SSR) 83-19. [9] West's

Social Security Reporting Service (Rulings Supp. Pamph. 1988) 90, 91-92

("An impairment 'meets' a listed condition . . . only when it manifests

the specific findings described in the set of medical criteria for that

listed impairment. . . . The level of severity in any particular listing

section is depicted by the given set of findings and not by the

degree of severity of any single medical finding -- no matter to what

extent that finding may exceed the listed value") (emphasis in

original).

dition . . . only when it manifests

the specific findings described in the set of medical criteria for that

listed impairment. . . . The level of severity in any particular listing

section is depicted by the given set of findings and not by the

degree of severity of any single medical finding -- no matter to what

extent that finding may exceed the listed value") (emphasis in

original).

For a claimant to qualify for benefits by showing that his unlisted

impairment, or combination of impairments, is "equivalent" to a listed

impairment, he must present medical findings equal in severity to all the criteria for the one most similar listed

impairment. [10] 20 CFR §

416.926(a) (a claimant's impairment is "equivalent" to a listed impairment

"if the medical findings are at least equal in severity" to the medical

criteria for "the listed impairment most like [the claimant's]

impairment"); SSR 83-19, at 92 (a claimant's impairment is "equivalent" to

a listing only if his symptoms, signs, and laboratory findings are "at

least equivalent in severity to" the criteria for "the listed impairment

most like the individual's impairment(s)"; when a person has a combination

of impairments, "the medical findings of the combined impairments will be

compared to the findings of the listed impairment most similar to the

individual's most severe

impairment"). [11] A claimant

cannot qualify for benefits under the "equivalence" step by showing that

the overall functional impact of his unlisted impairment or combination of

impairments is as severe as that of a listed impairment. SSR 83-19, at

92-93 ("it is incorrect to consider whether the listing is equaled on the

basis of an assessment of overall functional impairment. . . . The

functional consequences of the impairments . . . irrespective of their

nature or extent, cannot justify a determination of equivalence")

(emphasis in original).

combination of

impairments is as severe as that of a listed impairment. SSR 83-19, at

92-93 ("it is incorrect to consider whether the listing is equaled on the

basis of an assessment of overall functional impairment. . . . The

functional consequences of the impairments . . . irrespective of their

nature or extent, cannot justify a determination of equivalence")

(emphasis in original).

The Secretary explicitly has set the medical criteria defining the listed

impairments at a higher level of severity than the statutory standard. The

listings define impairments that would prevent an adult, regardless of his

age, education, or work experience, from performing any gainful

activity, not just "substantial gainful activity." See 20 CFR § 416.925(a)

(purpose of listings is to describe impairments" severe enough to prevent

a person from doing any gainful activity"); SSR 83-19, at 91 (listings

define "medical conditions which ordinarily prevent an individual from

engaging in any gainful activity"). The reason for this difference between

the listings' level of severity and the statutory standard is that, for

adults, the listings were designed to operate as a presumption of

disability that makes further inquiry necessary. That is, if an adult is

not actually working and his impairment matches or is equivalent to a

listed impairment, he is presumed unable to work, and is awarded benefits

without a determination whether he actually can perform his own prior work

or other work. See Yuckert , 482 U.S., at 141, 107 S.Ct., at 2291

(if an adult's impairment "meets or equals one of the listed impairments,

the claimant is conclusively presumed to be disabled

and his impairment matches or is equivalent to a

listed impairment, he is presumed unable to work, and is awarded benefits

without a determination whether he actually can perform his own prior work

or other work. See Yuckert , 482 U.S., at 141, 107 S.Ct., at 2291

(if an adult's impairment "meets or equals one of the listed impairments,

the claimant is conclusively presumed to be disabled. If the impairment is

not one that is conclusively presumed to be disabling, the evaluation

proceeds to the fourth step"; the listings "streamlin[e] the decision

process by identifying those claimants whose medical impairments are so

severe that it is likely they would be found disabled regardless of their

vocational background," id. , at 153, 107 S.Ct., at 2297); Bowen

v. City of New York , 476 U.S. 467; 471, 106 S.Ct. 2022, 2025, 90

L.Ed.2d 462 (1986) ("if a claimant's condition meets or equals the listed

impairments, he is conclusively presumed to be disabled and entitled to

benefits"; if not, "the process moves to the fourth step"); Campbell , 461 U.S., at 460, 103 S.Ct., at 1953 ("The regulations

recognize that certain impairments are so severe that they prevent a

person from pursuing any gainful work. . . . A claimant who establishes

that he suffers from one of these impairments will be considered disabled

without further inquiry. . . . If a claimant suffers from a less severe

impairment, the Secretary must determine whether the claimant retains the

ability to [work]").

ations

recognize that certain impairments are so severe that they prevent a

person from pursuing any gainful work. . . . A claimant who establishes

that he suffers from one of these impairments will be considered disabled

without further inquiry. . . . If a claimant suffers from a less severe

impairment, the Secretary must determine whether the claimant retains the

ability to [work]").

When the Secretary developed the child-disability listings, he set their

medical criteria at the same level of severity as that of the adult

listings. See 42 Fed. Reg. 14705 (1977) (the child-disability listings

describe impairments "of 'comparable severity' to the adult listing"); SSA

Disability Insurance Letter No.

III-11. [12] (Jan. 9, 1974,

App. 97 (child-disability listings describe impairments that affect

children "to the same extent as . . . the impairments listed in the adult

criteria" affect adults' ability to work).

Thus, the listings in several ways are more restrictive than the

statutory standard. First, the listings obviously do not cover all

illnesses and abnormalities that actually can be disabling. The Secretary

himself has characterized the adult listing as merely containing "over 100 examples of medical conditions which ordinarily prevent" a person

from working, and has recognized that "it is difficult to include in the

listing all the sets of medical findings which describe impairments severe

enough to prevent any gainful work." SSR 83-19, at 91 (emphasis added).

See also 50 Fed. Reg. 50068, 50069 (1985) (listings contain only the most

"frequently diagnosed" impairments); 44 Fed. Reg. 18170, 18175 (1979)

("The Listing criteria are intended to identify the more commonly

occurring impairments"). Similarly, when the Secretary published the

child-disability listings for comment in 1977, he described them as

including only the "more common impairments" affecting children. 42 Fed.

Reg

(1985) (listings contain only the most

"frequently diagnosed" impairments); 44 Fed. Reg. 18170, 18175 (1979)

("The Listing criteria are intended to identify the more commonly

occurring impairments"). Similarly, when the Secretary published the

child-disability listings for comment in 1977, he described them as

including only the "more common impairments" affecting children. 42 Fed.

Reg. 14706 (the child-disability listings "provide a means to efficiently

and equitably evaluate the more common

impairments"). [13]

Second, even those medical conditions that are covered in the listings

are defined by criteria setting a higher level of severity than the

statutory standard, so they exclude claimants who have listed impairments

in a form severe enough to preclude substantial gainful activity,

but not quite severe enough to meet the listings level -- that which would

preclude any gainful activity. Third, the listings also exclude any

claimant whose impairment would not prevent any and all persons from doing

any kind of work, but which actually precludes the particular claimant

from working, given its actual effects on him -- such as pain,

consequences of medication, and other symptoms that vary greatly with the

individual [14] -- and given

the claimant's age, education, and work experience. Fourth, the

equivalence analysis excludes claimants who have unlisted impairments, or

combinations of impairments, that do not fulfill all the criteria for any

one listed impairment. Thus, there are several obvious categories of

claimants who would not qualify under the listings, but who nonetheless

would meet the statutory standard.

the claimant's age, education, and work experience. Fourth, the

equivalence analysis excludes claimants who have unlisted impairments, or

combinations of impairments, that do not fulfill all the criteria for any

one listed impairment. Thus, there are several obvious categories of

claimants who would not qualify under the listings, but who nonetheless

would meet the statutory standard.

For adults , theses shortcomings of the listings are remedied at

the final, vocational steps of the Secretary's test. A claimant who does

not qualify for benefits under the listings, for any of the reasons

described above, still has the opportunity to show that his impairment in

fact prevents him from working. 20 CFR §§ 416.920(e) and (f); Yuckert , 482 U.S., at 141, 107 S.Ct., at 2291 (if an adult

claimant's "impairment is not one that is conclusively presumed to be

disabling, the evaluation proceeds" to the fourth and fifth steps); Campbell , 461 U.S., at 460, 103 S.Ct., at 1953 ("If a claimant

suffers from a less severe impairment" than the listed impairments, "the

Secretary must determine whether the claimant retains the ability to

perform either his former work or some less demanding

employment"). [15]

For children, however, there is no similar opportunity. Children whose

impairments are not quite severe enough to rise to the presumptively

disabling level set by the listings; children with impairments that might

not disable any and all children, but which actually disable them ,

due to symptomatic effects such as pain, nausea, side effects of

medication, etc., or due to their particular age, educational background,

and circumstances; and children with unlisted impairments or combinations

of impairments [16] that are

not equivalent to any one listing -- all these categories of child

claimants are simply denied benefits, even if their impairments are of

"comparable severity" to ones that would actually (though not

presumptively) render an adult

disabled. [17]

rticular age, educational background,

and circumstances; and children with unlisted impairments or combinations

of impairments [16] that are

not equivalent to any one listing -- all these categories of child

claimants are simply denied benefits, even if their impairments are of

"comparable severity" to ones that would actually (though not

presumptively) render an adult

disabled. [17]

The child-disability regulations are simply inconsistent with the

statutory standard of "comparable

severity." [18] This

inconsistency is aptly illustrated by the fact that the Secretary applies

the same approach to child-disability determinations under Title XVI and

to widows' and widowers' disability benefits under Title II, despite the

fact that Title II sets a stricter standard for widows' benefits. Under

the Secretary's regulations and rulings, both widows and children qualify

for benefits only if the medical evidence of their impairments

meets or equals a listing. SSR 83-19, at 94. Title II provides: "A widow .

. . or widower shall not be determined to be under a disability . . .

unless his or her . . . impairment or impairments are of a level of

severity which under regulations prescribed by the Secretary is deemed to

be sufficient to preclude an individual from engaging in any gainful

activity." 42 U.S.C. § 423(d)(2)(B). When Congress set out to provide

disabled children with benefits, it chose to link the disability standard not to this test, but instead to the more liberal test set forth in

§ 423(d)(2)(A) and in § 1382c(a)(3)(A) (any impairment making a claimant

"unable to engage in any substantial gainful activity" qualifies him for

benefits). The Secretary's regulations, treating child-disability claims

like claims for widows' benefits, nullify this congressional choice

chose to link the disability standard not to this test, but instead to the more liberal test set forth in

§ 423(d)(2)(A) and in § 1382c(a)(3)(A) (any impairment making a claimant

"unable to engage in any substantial gainful activity" qualifies him for

benefits). The Secretary's regulations, treating child-disability claims

like claims for widows' benefits, nullify this congressional choice. See Yuckert , 482 U.S., at 163-164, 107 S.Ct., at 2302-03 (dissenting

opinion) (contrasting widows' disability statute with the § 423(d)(2)(A)/§

1382c(a)(3) test, which requires an individualized inquiry as to whether

the claimant can work); S. Rep. No. 744, 90th Cong., 1st Sess., 49 (1967),

U.S. Code Cong. & Admin. News 1967, pp. 2834, 2883 (disabled widows'

statutory "test of disability . . . is somewhat more restrictive than that

for disabled workers").

V

The Secretary does not seriously dispute the disparity in his approach to

child and adult-disability determination. He argues, instead, that the

listings-only approach is the only practicable way to determine whether a

child's impairment is "comparable" to one that would disable an adult. An

individualized, functional approach to child-disability claims like that

provided for adults is not feasible, The Secretary asserts, since children

do not work; there is no available measure of their functional abilities

analogous to an adult's ability to work, so the only way to measure

"comparable severity" is to compare child claimants' medical evidence with

the standard of severity set by the listings. Laying to one side the

obvious point that such a comparison does not properly implement the

statute because the Secretary's current listings set a level of severity

higher than that prescribed by the statute, this argument still is not

persuasive

only way to measure

"comparable severity" is to compare child claimants' medical evidence with

the standard of severity set by the listings. Laying to one side the

obvious point that such a comparison does not properly implement the

statute because the Secretary's current listings set a level of severity

higher than that prescribed by the statute, this argument still is not

persuasive. Even if the listings were set at the same level of severity as

the statute, and expanded to cover many more childhood impairments, no set listings could ensure that child claimants would receive

benefits whenever their impairments are of "comparable severity" to ones

that would qualify an adult for benefits under the individualized,

functional analysis contemplated by the statute and provided to adults by

the Secretary. No decision process restricted to comparing claimants'

medical evidence to a fixed, finite set of medical criteria can respond

adequately to the infinite variety of medical conditions and combinations

thereof, the varying impact of such conditions due to the claimant's

individual characteristics, and the constant evolution of medical

diagnostic techniques.

The Secretary's claim that a functional analysis of child disability

claims is not feasible is unconvincing. The fact that a vocational analysis is inapplicable to children does not mean that a functional analysis cannot be applied to them. An inquiry into the

impact of an impairment on the normal daily activities of a child of the

claimant's age -- speaking, walking, washing, dressing, and feeding

oneself, going to school, playing, etc. -- is, in our view, no more

amorphous or unmanageable than an inquiry into the impact of an adult's

impairment on his ability to perform "any other kind of substantial

gainful work which exists in the national economy," §

1382c(a)(3)(B)

e normal daily activities of a child of the

claimant's age -- speaking, walking, washing, dressing, and feeding

oneself, going to school, playing, etc. -- is, in our view, no more

amorphous or unmanageable than an inquiry into the impact of an adult's

impairment on his ability to perform "any other kind of substantial

gainful work which exists in the national economy," §

1382c(a)(3)(B). [19] Moreover,

the Secretary tacitly acknowledges that functional assessment of child

claimants is possible, in that some of his own listings are defined in

terms of functional criteria. See, e.g. 20 CFR pt. 404, subpt. P, App. I

(pt. B), § 101.03 (listing for "Deficit of musculoskeletal function"

defined in terms of difficulty in walking or "[i]nability to perform

age-related personal self-care activities involving feeding, dressing, and

personal hygiene"); § 111.02(B) (listing for "Major motor seizures"

defined in terms of "Significant interference with communication" or

"Significant emotional disorder," or "Where significant adverse effects of

medication interfere with major daily activities"); § 112.05(C) (mental

retardation listing for claimants with IQ of 60-69 requiring "a physical

or other mental impairment imposing additional and significant restriction

of function or developmental

progression"). [20] Also, the

Secretary's own test for cessation for disability involves an examination

of a child claimant's ability to "perform age-appropriate activities." 20

CFR § 416.994(c). Finally, the Secretary's insistence that child claimants

must be assessed from "a medical perspective alone, without individualized

consideration of . . . residual functional capacity," Brief for Petitioner

45, seems to us to make little sense in light of the fact that standard

medical diagnostic techniques often include assessment of the functional

impact of the disorder. [21]

VI

4(c). Finally, the Secretary's insistence that child claimants

must be assessed from "a medical perspective alone, without individualized

consideration of . . . residual functional capacity," Brief for Petitioner

45, seems to us to make little sense in light of the fact that standard

medical diagnostic techniques often include assessment of the functional

impact of the disorder. [21]

VI

We conclude that the Secretary's regulations and rulings implementing the

child-disability statute simply do not carry out the statutory

requirements that SSI benefits shall be provided to children with "any . .

. impairment of comparable severity" to an impairment that would make an

adult "unable to engage in any substantial gainful activity." §

1382c(a)(3)(A). For that reason, the Secretary's approach to child

disability is "manifestly contrary to the statute," Chevron , 467

U.S., at 844, 104 S.Ct., at 2782, and exceeds his statutory authority.

The judgment of the Court of Appeals, vacating in part the District

Court's grant of summary judgment in the Secretary's favor as to the

claims of the plaintiff class, is affirmed.

It is so ordered.

Justice Blackmun delivered the opinion of the Court, in which Justices

Brennan, Marshall, Stevens, O'Connor, Scalia, and Kennedy joined. Justice

White filed a dissenting opinion, in which Chief Justice Rehnquist

joined.

[1] Social Security

Administration, Office of Disability, Preliminary Staff Report: Childhood

Disability Study, p. B-1 (Sept. 20, 1989).

[2] 42 U.S.C. § 405(a), made

applicable to Title XVI by § 1383(d)(1), reads:

[3] The regulations implementing

the Title II disability standard, 42 U.S.C. § 423(d), at issue in Yuckert , and those implementing the identical Title XVI standard, §

1382c(a)(3), at issue in this case, are the same in all relevant respects.

Compare 20 CFR §§ 404.1520-1530 with §§ 416.920-930 91989).

20, 1989).

[2] 42 U.S.C. § 405(a), made

applicable to Title XVI by § 1383(d)(1), reads:

[3] The regulations implementing

the Title II disability standard, 42 U.S.C. § 423(d), at issue in Yuckert , and those implementing the identical Title XVI standard, §

1382c(a)(3), at issue in this case, are the same in all relevant respects.

Compare 20 CFR §§ 404.1520-1530 with §§ 416.920-930 91989).

[4] Respondents Joseph Love and

Evelyn Raushi, two children who were denied benefits, are the other two

named plaintiffs in this action. All three named plaintiffs' individual

claims were eventually remanded to the Secretary by the District Court;

only the class claims remain before this Court.

[5] The first and Eleventh

Circuits have upheld the validity of the Secretary's approach to child

disability. Hinckley ex rel. Martin v. Secretary of Health and Human

Services , 742 F.2d 19 (CA1 1984); Powell ex rel. Powell v.

Schweiker , 688 F.2d 1357 (CA11 1982). Also the Fifth and Eighth

Circuits have ruled that the Secretary properly applied the

child-disability regulations to deny benefits in a particular case,

without explicitly addressing the question whether the regulations are

valid. Nash ex rel. Alexander v. Bowen , 882 F.2d 1291 (CA8 1989);

Burnside ex rel. Burnside v. Bowen, 845 F.2d 587 (CA5 1988). The Third

Circuit in the present case acknowledged the conflict. Zebley ex rel.

Zebley v. Bowen , 855 F.2d 67, 75 (1988).

child-disability regulations to deny benefits in a particular case,

without explicitly addressing the question whether the regulations are

valid. Nash ex rel. Alexander v. Bowen , 882 F.2d 1291 (CA8 1989);

Burnside ex rel. Burnside v. Bowen, 845 F.2d 587 (CA5 1988). The Third

Circuit in the present case acknowledged the conflict. Zebley ex rel.

Zebley v. Bowen , 855 F.2d 67, 75 (1988).

[6] There are 125 impairments

defined in the adult listings, and an additional 57 in the child listings.

The body system categories in the adult listings are: musculoskeletal,

special senses and speech, respiratory, cardiovascular, digestive,

genito-urinary, hemic and lymphatic, skin, and endocrine. In addition,

there are four groups of listings not categorized by body system: multiple

body system impairments, neurological impairments, mental disorders, and

malignant neoplastic diseases. The child- disability listings include, in

addition to all these, a category for growth impairment.

[7] For example, under the

"growth impairment" category of the child- disability listings, 20 CFR pt.

404, subpt. P. App. I (pt. B) § 100.00 et seq., there is a listing the

medical criteria of which require the claimant to show both a "[f]all of

greater than 25 percentiles in height which is sustained" and "[b]one age

greater than two standard deviations . . . below the mean for

chronological age." § 100.03. Another example is the listing for "mental

retardation," which requires that a child claimant show "[a]chievement of

only those developmental milestones generally acquired by children no more

than one-half the child's chronological age," or "IQ of 59 or less," or

"IQ of 60-69, inclusive, and a physical or other mental impairment

imposing additional and significant restriction of function or

developmental progression." § 112.05.

retardation," which requires that a child claimant show "[a]chievement of

only those developmental milestones generally acquired by children no more

than one-half the child's chronological age," or "IQ of 59 or less," or

"IQ of 60-69, inclusive, and a physical or other mental impairment

imposing additional and significant restriction of function or

developmental progression." § 112.05.

[8] For example, in the growth

impairment listing described in n. 7, supra , a child claimant whose

"bone age" was slightly less than two standard deviations below normal

would not qualify under the listing, even if his height was much more than

25 percentiles below normal.

[9] Social Security Rulings are

agency rulings "published under the authority of the Commissioner of

Social Security and are binding on all components of the Administration."

20 CFR § 422.408 (1989); see Heckler v. Edwards , 465 U.S. 870, 873,

n. 3, 104 S.Ct 1532, 1534, n. 3, 79 L.Ed.2d 878 (1984).

[10] For example, a child

claimant with Down syndrome (which currently is not a listed impairment),

a congenital disorder usually manifested by mental retardation, skeletal

deformity and cardiovascular and digestive problems, would have to fulfill

the criteria for whichever single listing his condition must resembled.

See Brief for National Easter Seal Society, et al. , as Amici

Curiae 17, n. 9.

[11] For example, if a child

has both a growth impairment slightly less severe than required by listing

§ 100.03, and is mentally retarded but has an IQ just above the cut-off

level set by § 112.04, he cannot qualify for benefits under the

"equivalence" analysis -- no matter how devastating the combined impact of

mental retardation and impaired physical growth.

[12] A Disability Insurance

Letter (DIL) is an internal directive sent by the Secretary to the state

agencies responsible for disability determinations. See Brief for

Petitioner 36.

above the cut-off

level set by § 112.04, he cannot qualify for benefits under the

"equivalence" analysis -- no matter how devastating the combined impact of

mental retardation and impaired physical growth.

[12] A Disability Insurance

Letter (DIL) is an internal directive sent by the Secretary to the state

agencies responsible for disability determinations. See Brief for

Petitioner 36.

[13] There are, as yet, no

specific listings for many well-known childhood impairments, including

spina bifida, Down syndrome, muscular dystrophy, autism, AIDS, infant drug

dependency, and fetal alcohol syndrome. See Brief for American Medical

Association, et al. , as Amici Curiae (AMA Brief) 22. The

Secretary, however, has proposed new listings for "Down syndrome and other

Hereditary, Congenital, and Acquired Disorders." 52 Fed. Reg. 37161

(1987). See Reply Brief for Petitioner 19, n. 16.

[14] The Secretary has stated

that the severity of perceived symptoms such as pain has no bearing on the

determination whether a claimant's impairment meets or equals a listing.

Social Security Ruling 82-58, DHHS Rulings, Cumulative Edition 1982, p.

121 ("No alleged or reported intensity of the symptoms can be substituted

to elevate impairment severity to equivalency. . . . [C]omplaints of

'severe,' 'extreme,' or 'constant' pain will not compensate for . . .

missing medical findings and permit an 'equals' determination") (emphasis

deleted).

[15] About 25% of adult

claimants qualify for benefits under steps four and five of the

Secretary's test. House Committee on Ways and Means, Background Material

and Data On Programs Within the Jurisdiction of the Committee on Ways and

Means, 1989 Ed., 101st Cong., 1st Sess., 46 (Comm. Print).

for . . .

missing medical findings and permit an 'equals' determination") (emphasis

deleted).

[15] About 25% of adult

claimants qualify for benefits under steps four and five of the

Secretary's test. House Committee on Ways and Means, Background Material

and Data On Programs Within the Jurisdiction of the Committee on Ways and

Means, 1989 Ed., 101st Cong., 1st Sess., 46 (Comm. Print).

[16] As the dissent points

out, post , at 899-900, 42 U.S.C. § 1382c(a)(3)(F) requires that

"the combined impact of [multiple] impairments shall be considered

throughout the disability determination process," and 20 CFR § 416.923

promises that "we will consider the combined effect of all your

impairments." This assurance may be of value to adult claimants, but not

to children, for whom the combined effect of multiple impairments is

considered only within the confines of the equivalence

determination, "whether the combination of your impairments is medically

equal to any listed impairment ." 20 CFR § 416.926(a). As the Court

of Appeals noted, if children are afforded the individualized

consideration given to adults, then § 416.923 would fulfill the

statutory mandate as to children with multiple impairments. 855 F.2d at

76.

[17] Empirical evidence

suggests that the rigidity of the Secretary's listings-only approach has a

severe impact on child claimants. There are many rare childhood diseases

that cannot meaningfully be compared with any of the listings. AMA Brief

6, 25 (it is unlikely "that any physician could make meaningful

comparisons between extremely rare diseases and the set medical criteria

listed by the Secretary"). Moreover, the listings-only approach disregards

factors such as pain, side effects of medication, feeding problems,

dependence on medical equipment, confinement at home, and frequent

hospitalization, that vary with each individual case

is unlikely "that any physician could make meaningful

comparisons between extremely rare diseases and the set medical criteria

listed by the Secretary"). Moreover, the listings-only approach disregards

factors such as pain, side effects of medication, feeding problems,

dependence on medical equipment, confinement at home, and frequent

hospitalization, that vary with each individual case. A recent study

suggests that children with multiple impairments, young children who

cannot be subjected to the clinical tests requires by the listings

criteria, and children whose impairments have a severe functional impact

but which do not match listings criteria, are often denied benefits. H.

Fox & A. Greaney, Disabled Children's Access to Supplemental Security

Income and Medicaid Benefits (1988).

A telling example of the effect of the listings-only approach is found in Wilkinson ex rel. Wilkinson v. Bowen , 847 F.2d 660 (CA11 1987)

(child with rare liver disorder causing severe swelling, food allergies

and fever, and requiring constant care and confinement at home, does not

qualify for benefits because his impairment does not meet or equal the

criteria for any listing); see also Zebley ex rel. Zebley v. Bowen ,

855 F.2d 67 (CA3 1988) (plaintiff Zebley denied benefits, despite evidence

of congenital brain damage, mental retardation, development delay, eye

problems and musculoskeletal impairment, because his condition did not

meet or equal any listing).

not

qualify for benefits because his impairment does not meet or equal the

criteria for any listing); see also Zebley ex rel. Zebley v. Bowen ,

855 F.2d 67 (CA3 1988) (plaintiff Zebley denied benefits, despite evidence

of congenital brain damage, mental retardation, development delay, eye

problems and musculoskeletal impairment, because his condition did not

meet or equal any listing).

The disparity in the Secretary's treatment of child and adult claimants

is thrown into sharp relief in cases where an unsuccessful child claimant,

upon reaching age 18, is awarded benefits on the basis of the same impairment deemed insufficient to qualify him for child disability

benefits. See, e.g., Wills v. Secretary of Health and Human

Services , 686 F. Supp. 171, 172, and n. 1 (WD Mich. 1987); Brief of

National Organization of Social Security Claimants' Representatives as Amicus Curiae , A-3 to A-24 (ALJ decisions awarding benefits when

child claimant turns 18). See also Tr. of Oral Arg. 13-14.

[18] The dissent proposes that

children who fail to qualify for benefits under the Secretary's current

approach can simply "make their case before the Secretary, and take the

case to court if their claims are rejected." Post , at 898-899. We

fail to see why each child denied benefits because of his impairment falls

within the several categories of impairments that meet the statutory

standard but do not qualify under the Secretary's listings-only approach,

should be compelled to raise a separate, as-applied challenge to the

regulations, or why a facial challenge is not a proper response to the

systemic disparity between the statutory standard and the Secretary's

approach to child disability claims.

within the several categories of impairments that meet the statutory

standard but do not qualify under the Secretary's listings-only approach,

should be compelled to raise a separate, as-applied challenge to the

regulations, or why a facial challenge is not a proper response to the

systemic disparity between the statutory standard and the Secretary's

approach to child disability claims.

[19] The Secretary's own

regulations state that this inquiry involves assessment of an adult

claimant's ability to "do physical activities such as walking, standing,

lifting, carrying, pushing, pulling, reaching, handling," and his ability

"to carry out and remember instructions, and to respond appropriately to

supervision, co-workers and work pressures in a work setting." 20 CFR §§

416.945(b) and (c) (1989). It is difficult to see why such functional

assessment would be feasible for adults and not for children.

[20] The Secretary contends

that, because some of the child-disability listings include functional

criteria, his approach to child disability adequately takes account of

functional considerations. Brief for Petitioner 42. This argument is

unavailing. The fact that some of the listed impairments are defined in

terms of functional criteria is small comfort to child claimants who do

not have one of those impairments, and who fail to qualify for benefit for

one of the reasons discussed above.

[21] See AMA Brief 5 ("The

view that proper study or treatment of pediatric illness and injury must

include an assessment of the child's functional capacity to perform

age-appropriate activities is well accepted in the medical community. . .

. The biological severity of an illness is an abstraction, measured only

by proxies, the most familiar of which are physiological severity,

functional severity and burden of illness").