Social Security Ruling 16-3p; Titles II and XVI: Evaluation of Symptoms in Disability Claims, 14166-14172 [2016-05916]
Download as PDF
<![CDATA[
14166
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
manipulative acts and practices, to
promote just and equitable principles of
trade,’’ and ‘‘to protect investors and the
public interest.’’ 23
III. Procedure: Request for Written
Comments
The Commission requests that
interested persons provide written
submissions of their views, data, and
arguments with respect to the issues
identified above, as well as any other
concerns they may have with the
proposal. In particular, the Commission
invites the written views of interested
persons concerning whether the
proposal is consistent with Section
6(b)(5) or any other provision of the Act,
or the rules and regulations thereunder.
Although there do not appear to be any
issues relevant to approval or
disapproval that would be facilitated by
an oral presentation of views, data, and
arguments, the Commission will
consider, pursuant to Rule 19b–4, any
request for an opportunity to make an
oral presentation.24
Interested persons are invited to
submit written data, views, and
arguments regarding whether the
proposal should be approved or
disapproved by April 6, 2016. Any
person who wishes to file a rebuttal to
any other person’s submission must file
that rebuttal by April 20, 2016. The
Commission asks that commenters
address the sufficiency of the
Exchange’s statements in support of the
proposal, which are set forth in the
Notice 25 and in Amendment No. 1 to
the proposed rule change,26 in addition
to any other comments they may wish
to submit about the proposed rule
change.
The Exchange provides that the Fund
may invest in one or more of the
following broad categories of Municipal
Bonds: (a) General obligation bonds; (b)
revenue bonds; (c) discount bonds; (d)
premium bonds; (e) zero coupon bonds;
and (f) private activity bonds. Moreover,
the Exchange represents that: (i) Each
Municipal Bond held by the Fund must
be a constituent of a deal where the
deal’s original offering amount was at
least $100 million; (ii) no Municipal
mstockstill on DSK4VPTVN1PROD with NOTICES
23 15
U.S.C. 78f(b)(5).
24 Section 19(b)(2) of the Act, as amended by the
Securities Act Amendments of 1975, Public Law
94–29 (June 4, 1975), grants the Commission
flexibility to determine what type of proceeding—
either oral or notice and opportunity for written
comments—is appropriate for consideration of a
particular proposal by a self-regulatory
organization. See Securities Act Amendments of
1975, Senate Comm. on Banking, Housing & Urban
Affairs, S. Rep. No. 75, 94th Cong., 1st Sess. 30
(1975).
25 See supra note 3.
26 See supra note 4.
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
Bond held by the Fund will exceed 30%
of the Fund’s net assets, and the five
most heavily weighted Municipal Bonds
held by the Fund will not in the
aggregate account for more than 50% of
the Fund’s assets; and (iii) the Fund will
hold Municipal Bonds of a minimum of
13 non-affiliated issuers. Apart from
these broad representations, the
Exchange provides no other information
about the kinds of municipal bonds in
which the Fund may invest.
Accordingly, the Commission seeks
comment on whether the Exchange’s
representations relating to the
Municipal Bonds to be held by the Fund
are sufficiently clear in their application
to municipal bonds, specifically, and
are consistent with the requirements of
Section 6(b)(5) of the Act, which, among
other things, requires that the rules of an
exchange be designed to prevent
fraudulent and manipulative acts and
practices.
Comments may be submitted by any
of the following methods:
Electronic Comments
• Use the Commission’s Internet
comment form (https://www.sec.gov/
rules/sro.shtml); or
• Send an email to rule-comments@
sec.gov. Please include File Number SR–
NYSEArca–2015–93 on the subject line.
Paper Comments
• Send paper comments in triplicate
to Secretary, Securities and Exchange
Commission, 100 F Street NE.,
Washington, DC 20549–1090.
All submissions should refer to File
Numbers SR–NYSEArca–2015–93. This
file number should be included on the
subject line if email is used. To help the
Commission process and review your
comments more efficiently, please use
only one method. The Commission will
post all comments on the Commission’s
Internet Web site (https://www.sec.gov/
rules/sro.shtml). Copies of the
submission, all subsequent
amendments, all written statements
with respect to the proposed rule
change that are filed with the
Commission, and all written
communications relating to the
proposed rule change between the
Commission and any person, other than
those that may be withheld from the
public in accordance with the
provisions of 5 U.S.C. 552, will be
available for Web site viewing and
printing in the Commission’s Public
Reference Room, 100 F Street NE.,
Washington, DC 20549, on official
business days between the hours of
10:00 a.m. and 3:00 p.m. Copies of these
filings also will be available for
inspection and copying at the principal
PO 00000
Frm 00088
Fmt 4703
Sfmt 4703
office of the Exchange. All comments
received will be posted without change;
the Commission does not edit personal
identifying information from
submissions. You should submit only
information that you wish to make
available publicly. All submissions
should refer to File Number SR–
NYSEArca–2015–93 and should be
submitted on or before April 6, 2016.
Rebuttal comments should be submitted
by April 20,2016.
For the Commission, by the Division of
Trading and Markets, pursuant to delegated
authority.27
Robert W. Errett,
Deputy Secretary.
[FR Doc. 2016–05855 Filed 3–15–16; 8:45 am]
BILLING CODE 8011–01–P
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA–2015–0055]
Social Security Ruling 16–3p; Titles II
and XVI: Evaluation of Symptoms in
Disability Claims
Social Security Administration.
Notice of Social Security Ruling
AGENCY:
ACTION:
(SSR).
We are providing notice of
SSR 16–3p. This Ruling supersedes SSR
96–7p. This Ruling provides guidance
about how we evaluate statements
regarding the intensity, persistence, and
limiting effects of symptoms in
disability claims under Titles II and XVI
of the Social Security Act (Act) and
blindness claims under Title XVI of the
Act.
DATES: Effective Date: March 16, 2016.
FOR FURTHER INFORMATION CONTACT:
Elaine Tocco, Office of Disability Policy,
Social Security Administration, 6401
Security Boulevard, Baltimore, MD
21235–6401, (410) 966–6356. For
information on eligibility or filing for
benefits, call our national toll-free
number, 1–800–772–1213 or TTY 1–
800–325–0778, or visit our internet site,
Social Security Online, at https://
www.socialsecurity.gov.
SUMMARY:
Although
5 U.S.C. 552(a)(1) and (a)(2) do not
require us to publish this SSR, we are
doing so in accordance with 20 CFR
402.35(b)(1).
Through SSRs, we convey to the
public SSA precedential decisions
relating to the Federal old age,
survivors, disability, supplemental
security income, and special veterans
benefits programs. We may base SSRs
SUPPLEMENTARY INFORMATION:
27 17
E:\FR\FM\16MRN1.SGM
CFR 200.30–3(a)(57).
16MRN1
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
on determinations or decisions made at
all levels of administrative adjudication,
Federal court decisions, Commissioner’s
decisions, opinions of the Office of the
General Counsel, or other
interpretations of the law and
regulations.
Although SSRs do not have the same
force and effect as statutes or
regulations, they are binding on all
components of the Social Security
Administration. 20 CFR 402.35(b)(1).
This SSR will remain in effect until
we publish a notice in the Federal
Register that rescinds it, or we publish
a new SSR that replaces or modifies it.
(Catalog of Federal Domestic Assistance,
Programs Nos. 96.001, Social Security—
Disability Insurance; 96.002, Social
Security—Retirement Insurance; 96.004,
Social Security—Survivors Insurance;
96.006—Supplemental Security Income.)
Dated: March 9, 2016.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
Policy Interpretation Ruling
mstockstill on DSK4VPTVN1PROD with NOTICES
Titles II and XVI: Evaluation of
Symptoms in Disability Claims
This SSR supersedes SSR 96–7p:
Policy Interpretation Ruling Titles II and
XVI: Evaluation of Symptoms in
Disability Claims: Assessing the
Credibility of an Individual’s
Statements.
Purpose:
We are rescinding SSR 96–7p: Policy
Interpretation Ruling Titles II and XVI
Evaluation of Symptoms in Disability
Claims: Assessing the Credibility of an
Individual’s Statements and replacing it
with this Ruling. We solicited a study
and recommendations from the
Administrative Conference of the
United States (ACUS) on the topic of
symptom evaluation. Based on ACUS’s
recommendations 1 and our adjudicative
1 ACUS made several recommendations in its
March 12, 2015 final report, ‘‘Evaluating Subjective
Symptoms in Disability Claims.’’ Among other
things, ACUS recommended we consider amending
SSR 96–7p to clarify that subjective symptom
evaluation is not an examination of an individual’s
character, but rather is an evidence-based analysis
of the administrative record to determine whether
the nature, intensity, frequency, or severity of an
individual’s symptoms impact his or her ability to
work. In any revised SSR, ACUS also recommended
we more closely follow our regulatory language
about symptom evaluation, which does not use the
term ‘‘credibility’’ and instead directs adjudicators
to consider medical and other evidence to evaluate
the intensity and persistence of symptoms to
determine how the individual’s symptoms limit
capacity for work if he or she is an adult, or for a
child with a title XVI disability claim, how
symptoms limit ability to function. ACUS further
recommended when revising SSR 96–7p, we offer
additional guidance to adjudicators on regulatory
implementation problems that have been identified
since we published SSR 96–7p.
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
experience, we are eliminating the use
of the term ‘‘credibility’’ from our subregulatory policy, as our regulations do
not use this term. In doing so, we clarify
that subjective symptom evaluation is
not an examination of an individual’s
character. Instead, we will more closely
follow our regulatory language regarding
symptom evaluation.
Consistent with our regulations, we
instruct our adjudicators to consider all
of the evidence in an individual’s record
when they evaluate the intensity and
persistence of symptoms after they find
that the individual has a medically
determinable impairment(s) that could
reasonably be expected to produce those
symptoms. We evaluate the intensity
and persistence of an individual’s
symptoms so we can determine how
symptoms limit ability to perform workrelated activities for an adult and how
symptoms limit ability to function
independently, appropriately, and
effectively in an age-appropriate manner
for a child with a title XVI disability
claim.
Citations (Authority):
Sections 216(i), 223(d), and 1614(a)(3)
of the Social Security Act as amended;
Regulations no. 4, sections 404.1508,
404.1512(d), 404.1513, 404.1520,
404.1526, 404.1527, 404.1528, 404.1529,
404.1545 and 404.1594; and Regulations
No. 16 sections 416.908, 416.912(d),
416.913, 416.920, 416.924(c),
416.924a(b)(9)(ii–iii), 416.926a, 416.927,
416.928, 416.929, 416.930(c), 416.945,
416.994, and 416.994a.
Background:
In determining whether an individual
is disabled, we consider all of the
individual’s symptoms, including pain,
and the extent to which the symptoms
can reasonably be accepted as consistent
with the objective medical and other
evidence in the individual’s record. We
define a symptom as the individual’s
own description or statement of his or
her physical or mental impairment(s).2
Under our regulations, an individual’s
statements of symptoms alone are not
enough to establish the existence of a
physical or mental impairment or
disability. However, if an individual
alleges impairment-related symptoms,
we must evaluate those symptoms using
a two-step process set forth in our
regulations.3
First, we must consider whether there
is an underlying medically determinable
physical or mental impairment(s) that
could reasonably be expected to
produce an individual’s symptoms,
2 See 20 CFR 404.1528(a) and 416.928(a) for how
our regulations define symptoms.
3 See 20 CFR 404.1529 and 416.929 for how we
evaluate statements of symptoms.
PO 00000
Frm 00089
Fmt 4703
Sfmt 4703
14167
such as pain. Second, once an
underlying physical or mental
impairment(s) that could reasonably be
expected to produce an individual’s
symptoms is established, we evaluate
the intensity and persistence of those
symptoms to determine the extent to
which the symptoms limit an
individual’s ability to perform workrelated activities for an adult or to
function independently, appropriately,
and effectively in an age-appropriate
manner for a child with a title XVI
disability claim.
This ruling clarifies how we consider:
• The intensity, persistence, and
functionally limiting effects of
symptoms,
• Objective medical evidence when
evaluating symptoms,
• Other evidence when evaluating
symptoms,
• The factors set forth in 20 CFR
404.1529(c)(3) and 416.929(c)(3),
• The extent to which an individual’s
symptoms affect his or her ability to
perform work-related activities or
function independently, appropriately,
and effectively in an age-appropriate
manner for a child with a title XVI
disability claim, and
• Adjudication standards for
evaluating symptoms in the sequential
evaluation process.
Policy Interpretation:
We use a two-step process for
evaluating an individual’s symptoms.
The two-step process:
Step 1: We Determine Whether the
Individual Has a Medically
Determinable Impairment (MDI) That
Could Reasonably be Expected To
Produce the Individual’s Alleged
Symptoms
An individual’s symptoms, such as
pain, fatigue, shortness of breath,
weakness, nervousness, or periods of
poor concentration will not be found to
affect the ability to perform work-related
activities for an adult or to function
independently, appropriately, and
effectively in an age-appropriate manner
for a child with a title XVI disability
claim unless medical signs or laboratory
findings show a medically determinable
impairment is present. Signs are
anatomical, physiological, or
psychological abnormalities established
by medically acceptable clinical
diagnostic techniques that can be
observed apart from an individual’s
symptoms.4 Laboratory findings are
anatomical, physiological, or
psychological phenomena, which can be
shown by the use of medically
4 See 20 CFR 404.1528(b) and 416.928(b) for how
our regulations define signs.
E:\FR\FM\16MRN1.SGM
16MRN1
mstockstill on DSK4VPTVN1PROD with NOTICES
14168
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
acceptable laboratory diagnostic
techniques.5 We call the medical
evidence that provides signs or
laboratory findings objective medical
evidence. We must have objective
medical evidence from an acceptable
medical source 6 to establish the
existence of a medically determinable
impairment that could reasonably be
expected to produce an individual’s
alleged symptoms.7
In determining whether there is an
underlying medically determinable
impairment that could reasonably be
expected to produce an individual’s
symptoms, we do not consider whether
the severity of an individual’s alleged
symptoms is supported by the objective
medical evidence. For example, if an
individual has a medically determinable
impairment established by a knee x-ray
showing mild degenerative changes and
he or she alleges extreme pain that
limits his or her ability to stand and
walk, we will find that individual has
a medically determinable impairment
that could reasonably be expected to
produce the symptom of pain. We will
proceed to step two of the two-step
process, even though the level of pain
an individual alleges may seem out of
proportion with the objective medical
evidence.
In some instances, the objective
medical evidence clearly establishes
that an individual’s symptoms are due
to a medically determinable
impairment. At other times, we may
have insufficient evidence to determine
whether an individual has a medically
determinable impairment that could
potentially account for his or her alleged
symptoms. In those instances, we
develop evidence regarding a potential
medically determinable impairment
using a variety of means set forth in our
regulations. For example, we may obtain
additional information from the
individual about the nature of his or her
symptoms and their effect on
functioning. We may request additional
information from the individual about
other testing or treatment he or she may
have undergone for the symptoms. We
may request clarifying information from
an individual’s medical sources, or we
may send an individual to a
consultative examination that may
include diagnostic testing. We may use
our agency experts to help us determine
whether an individual’s medically
determinable impairment could
5 See 20 CFR 404.1528(c) and 416.928(c) for how
our regulations define laboratory findings.
6 See 20 CFR 404.1513(a) and 416.913(a) for a list
of acceptable medical sources.
7 See 20 CFR 404.1508 and 416.908 for what is
needed to show a medically determinable
impairment.
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
reasonably be expected to produce his
or her symptoms. At the administrative
law judge hearing level or the Appeals
Council level of the administrative
review process, we may ask for and
consider evidence from a medical or
psychological expert to help us
determine whether an individual’s
medically determinable impairment
could reasonably be expected to
produce his or her symptoms. If an
individual alleges symptoms, but the
medical signs and laboratory findings
do not substantiate any medically
determinable impairment capable of
producing the individual’s alleged
symptoms, we will not evaluate the
individual’s symptoms at step two of
our two-step evaluation process.
We will not find an individual
disabled based on alleged symptoms
alone. If there is no medically
determinable impairment, or if there is
a medically determinable impairment,
but the impairment(s) could not
reasonably be expected to produce the
individual’s symptoms, we will not find
those symptoms affect the ability to
perform work-related activities for an
adult or ability to function
independently, appropriately, and
effectively in an age-appropriate manner
for a child with a title XVI disability
claim.
Step 2: We Evaluate the Intensity and
Persistence of an Individual’s
Symptoms Such as Pain and Determine
the Extent to Which an Individual’s
Symptoms Limit His or Her Ability To
Perform Work-Related Activities for an
Adult or To Function Independently,
Appropriately, and Effectively in an
Age-Appropriate Manner for a Child
With a Title XVI Disability Claim
Once the existence of a medically
determinable impairment that could
reasonably be expected to produce pain
or other symptoms is established, we
recognize that some individuals may
experience symptoms differently and
may be limited by symptoms to a greater
or lesser extent than other individuals
with the same medical impairments, the
same objective medical evidence, and
the same non-medical evidence. In
considering the intensity, persistence,
and limiting effects of an individual’s
symptoms, we examine the entire case
record, including the objective medical
evidence; an individual’s statements
about the intensity, persistence, and
limiting effects of symptoms; statements
and other information provided by
medical sources and other persons; and
any other relevant evidence in the
individual’s case record.
We will not evaluate an individual’s
symptoms without making every
PO 00000
Frm 00090
Fmt 4703
Sfmt 4703
reasonable effort to obtain a complete
medical history 8 unless the evidence
supports a finding that the individual is
disabled. We will not evaluate an
individual’s symptoms based solely on
objective medical evidence unless that
objective medical evidence supports a
finding that the individual is disabled.
We will evaluate an individual’s
symptoms based on the evidence in an
individual’s record as described below;
however, not all of the types of evidence
described below will be available or
relevant in every case.
1. Consideration of Objective Medical
Evidence
Symptoms cannot always be
measured objectively through clinical or
laboratory diagnostic techniques.
However, objective medical evidence is
a useful indicator to help make
reasonable conclusions about the
intensity and persistence of symptoms,
including the effects those symptoms
may have on the ability to perform
work-related activities for an adult or to
function independently, appropriately,
and effectively in an age-appropriate
manner for a child with a title XVI
claim.9 We must consider whether an
individual’s statements about the
intensity, persistence, and limiting
effects of his or her symptoms are
consistent with the medical signs and
laboratory findings of record.
The intensity, persistence, and
limiting effects of many symptoms can
be clinically observed and recorded in
the medical evidence. Examples such as
reduced joint motion, muscle spasm,
sensory deficit, and motor disruption
illustrate findings that may result from,
or be associated with, the symptom of
pain.10 These findings may be
consistent with an individual’s
statements about symptoms and their
functional effects. However, when the
results of tests are not consistent with
other evidence in the record, they may
be less supportive of an individual’s
statements about pain or other
symptoms than test results and
statements that are consistent with other
evidence in the record.
For example, an individual with
reduced muscle strength testing who
indicates that for the last year pain has
limited his or her standing and walking
8 By ‘‘complete medical history,’’ we mean the
individual’s complete medical history for at least
the 12 months preceding the month in which he or
she filed an application, unless there is a reason to
believe that development of an earlier period is
necessary or the individual says that his or her
alleged disability began less than 12 months before
he or she filed an application. 20 CFR 404.1512(d)
and 416.912(d).
9 See 20 CFR 404.1529(c)(2) and 416.929(c)(2).
10 See 20 CFR 404.1529(c)(2) and 416.929(c)(2).
E:\FR\FM\16MRN1.SGM
16MRN1
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
to no more than a few minutes a day
would be expected to have some signs
of muscle wasting as a result. If no
muscle wasting were present, we might
not, depending on the other evidence in
the record, find the individual’s reduced
muscle strength on clinical testing to be
consistent with the individual’s alleged
impairment-related symptoms.
However, we will not disregard an
individual’s statements about the
intensity, persistence, and limiting
effects of symptoms solely because the
objective medical evidence does not
substantiate the degree of impairmentrelated symptoms alleged by the
individual.11 A report of minimal or
negative findings or inconsistencies in
the objective medical evidence is one of
the many factors we must consider in
evaluating the intensity, persistence,
and limiting effects of an individual’s
symptoms.
2. Consideration of Other Evidence
If we cannot make a disability
determination or decision that is fully
favorable based solely on objective
medical evidence, then we carefully
consider other evidence in the record in
reaching a conclusion about the
intensity, persistence, and limiting
effects of an individual’s symptoms.
Other evidence that we will consider
includes statements from the individual,
medical sources, and any other sources
that might have information about the
individual’s symptoms, including
agency personnel, as well as the factors
set forth in our regulations.12 For
example, for a child with a title XVI
disability claim, we will consider
evidence submitted from educational
agencies and personnel, statements from
parents and other relatives, and
evidence submitted by social welfare
agencies, therapists, and other
practitioners.13
mstockstill on DSK4VPTVN1PROD with NOTICES
a. The Individual
An individual may make statements
about the intensity, persistence, and
limiting effects of his or her symptoms.
If a child with a title XVI disability
claim is unable to describe his or her
symptoms adequately, we will accept a
description of his or her symptoms from
the person most familiar with the child,
such as a parent, another relative, or a
guardian.14 For an adult whose
impairment prevents him or her from
describing symptoms adequately, we
may also consider a description of his
11 See
20 CFR 404.1529 and 416.929.
20 CFR 404.1513 and 416.913.
13 See 20 CFR 404.1529(c)(3) and 416.929(c)(3).
14 See 20 CFR 416.928(a).
12 See
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
or her symptoms from a person who is
familiar with the individual.
An individual may make statements
about symptoms directly to medical
sources, other sources, or he or she may
make them directly to us. An individual
may have made statements about
symptoms in connection with claims for
other types of disability benefits such as
workers’ compensation, benefits under
programs of the Department of Veterans
Affairs, or private insurance benefits.
An individual’s statements may
address the frequency and duration of
the symptoms, the location of the
symptoms, and the impact of the
symptoms on the ability to perform
daily living activities. An individual’s
statements may also include activities
that precipitate or aggravate the
symptoms, medications and treatments
used, and other methods used to
alleviate the symptoms. We will
consider an individual’s statements
about the intensity, persistence, and
limiting effects of symptoms, and we
will evaluate whether the statements are
consistent with objective medical
evidence and the other evidence.
b. Medical Sources
Medical sources may offer diagnoses,
prognoses, and opinions as well as
statements and medical reports about an
individual’s history, treatment,
responses to treatment, prior work
record, efforts to work, daily activities,
and other information concerning the
intensity, persistence, and limiting
effects of an individual’s symptoms.
Important information about
symptoms recorded by medical sources
and reported in the medical evidence
may include, but is not limited to, the
following:
• Onset, description of the character
and location of the symptoms,
precipitating and aggravating factors,
frequency and duration, change over a
period of time (e.g., whether worsening,
improving, or static), and daily
activities. Very often, the individual has
provided this information to the
medical source, and the information
may be compared with the individual’s
other statements in the case record. In
addition, the evidence provided by a
medical source may contain medical
opinions about the individual’s
symptoms and their effects. Our
adjudicators will weigh such opinions
by applying the factors in 20 CFR
404.1527 and 416.927.
• A longitudinal record of any
treatment and its success or failure,
including any side effects of medication.
• Indications of other impairments,
such as potential mental impairments,
PO 00000
Frm 00091
Fmt 4703
Sfmt 4703
14169
that could account for an individual’s
allegations.
Medical evidence from medical
sources that have not treated or
examined the individual is also
important in the adjudicator’s
evaluation of an individual’s statements
about pain or other symptoms. For
example, State agency medical and
psychological consultants and other
program physicians and psychologists
may offer findings about the existence
and severity of an individual’s
symptoms. We will consider these
findings in evaluating the intensity,
persistence, and limiting effects of the
individual’s symptoms. Adjudicators at
the hearing level or at the Appeals
Council level must consider the findings
from these medical sources even though
they are not bound by them.15
c. Non-Medical Sources
Other sources may provide
information from which we may draw
inferences and conclusions about an
individual’s statements that would be
helpful to us in assessing the intensity,
persistence, and limiting effects of
symptoms. Examples of such sources
include public and private agencies,
other practitioners, educational
personnel, non-medical sources such as
family and friends, and agency
personnel. We will consider any
statements in the record noted by
agency personnel who previously
interviewed the individual, whether in
person or by telephone. The adjudicator
will consider any personal observations
of the individual in terms of how
consistent those observations are with
the individual’s statements about his or
her symptoms as well as with all of the
evidence in the file.
d. Factors To Consider In Evaluating the
Intensity, Persistence and Limiting
Effects of an Individual’s Symptoms
In addition to using all of the
evidence to evaluate the intensity,
persistence, and limiting effects of an
individual’s symptoms, we will also use
the factors set forth in 20 CFR
404.1529(c)(3) and 416.929(c)(3). These
factors include:
1. Daily activities;
2. The location, duration, frequency,
and intensity of pain or other
symptoms;
3. Factors that precipitate and
aggravate the symptoms;
4. The type, dosage, effectiveness, and
side effects of any medication an
individual takes or has taken to alleviate
pain or other symptoms;
15 See
E:\FR\FM\16MRN1.SGM
20 CFR 404.1527 and 416.927.
16MRN1
14170
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
mstockstill on DSK4VPTVN1PROD with NOTICES
5. Treatment, other than medication,
an individual receives or has received
for relief of pain or other symptoms;
6. Any measures other than treatment
an individual uses or has used to relieve
pain or other symptoms (e.g., lying flat
on his or her back, standing for 15 to 20
minutes every hour, or sleeping on a
board); and
7. Any other factors concerning an
individual’s functional limitations and
restrictions due to pain or other
symptoms.
We will consider other evidence to
evaluate only the factors that are
relevant to assessing the intensity,
persistence, and limiting effects of the
individual’s symptoms. If there is no
information in the evidence of record
regarding one of the factors, we will not
discuss that specific factor in the
determination or decision because it is
not relevant to the case. We will discuss
the factors pertinent to the evidence of
record.
How We Will Determine if an
Individual’s Symptoms Affect the
Ability To Perform Work-Related
Activities for an Adult, or AgeAppropriate Activities for a Child With
a Title XVI Disability Claim
If an individual’s statements about the
intensity, persistence, and limiting
effects of symptoms are consistent with
the objective medical evidence and the
other evidence of record, we will
determine that the individual’s
symptoms are more likely to reduce his
or her capacities to perform workrelated activities for an adult or reduce
a child’s ability to function
independently, appropriately, and
effectively in an age-appropriate manner
for a child with a title XVI disability
claim.16 In contrast, if an individual’s
statements about the intensity,
persistence, and limiting effects of
symptoms are inconsistent with the
objective medical evidence and the
other evidence, we will determine that
the individual’s symptoms are less
likely to reduce his or her capacities to
perform work-related activities or
abilities to function independently,
appropriately, and effectively in an ageappropriate manner.
We may or may not find an
individual’s symptoms and related
limitations consistent with the evidence
in his or her record. We will explain
which of an individual’s symptoms we
found consistent or inconsistent with
the evidence in his or her record and
how our evaluation of the individual’s
symptoms led to our conclusions. We
will evaluate an individual’s symptoms
16 See
20 CFR 404.1529(c)(4) and 416.929(c)(4).
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
considering all the evidence in his or
her record.
In determining whether an
individual’s symptoms will reduce his
or her corresponding capacities to
perform work-related activities or
abilities to function independently,
appropriately, and effectively in an ageappropriate manner, we will consider
the consistency of the individual’s own
statements. To do so, we will compare
statements an individual makes in
connection with the individual’s claim
for disability benefits with any existing
statements the individual made under
other circumstances.
We will consider statements an
individual made to us at each prior step
of the administrative review process, as
well as statements the individual made
in any subsequent or prior disability
claims under titles II and XVI. If an
individual’s various statements about
the intensity, persistence, and limiting
effects of symptoms are consistent with
one another and consistent with the
objective medical evidence and other
evidence in the record, we will
determine that an individual’s
symptoms are more likely to reduce his
or her capacities for work-related
activities or reduce the abilities to
function independently, appropriately,
and effectively in an age-appropriate
manner. However, inconsistencies in an
individual’s statements made at varying
times does not necessarily mean they
are inaccurate. Symptoms may vary in
their intensity, persistence, and
functional effects, or may worsen or
improve with time. This may explain
why an individual’s statements vary
when describing the intensity,
persistence, or functional effects of
symptoms.
We will consider an individual’s
attempts to seek medical treatment for
symptoms and to follow treatment once
it is prescribed when evaluating
whether symptom intensity and
persistence affect the ability to perform
work-related activities for an adult or
the ability to function independently,
appropriately, and effectively in an ageappropriate manner for a child with a
title XVI disability claim. Persistent
attempts to obtain relief of symptoms,
such as increasing dosages and changing
medications, trying a variety of
treatments, referrals to specialists, or
changing treatment sources may be an
indication that an individual’s
symptoms are a source of distress and
may show that they are intense and
persistent.17
In contrast, if the frequency or extent
of the treatment sought by an individual
17 See
PO 00000
20 CFR 404.1529(c) and 416.929(c).
Frm 00092
Fmt 4703
Sfmt 4703
is not comparable with the degree of the
individual’s subjective complaints, or if
the individual fails to follow prescribed
treatment that might improve
symptoms, we may find the alleged
intensity and persistence of an
individual’s symptoms are inconsistent
with the overall evidence of record. We
will not find an individual’s symptoms
inconsistent with the evidence in the
record on this basis without considering
possible reasons he or she may not
comply with treatment or seek treatment
consistent with the degree of his or her
complaints. We may need to contact the
individual regarding the lack of
treatment or, at an administrative
proceeding, ask why he or she has not
complied with or sought treatment in a
manner consistent with his or her
complaints. When we consider the
individual’s treatment history, we may
consider (but are not limited to) one or
more of the following:
• An individual may have structured
his or her activities to minimize
symptoms to a tolerable level by
avoiding physical activities or mental
stressors that aggravate his or her
symptoms.
• An individual may receive periodic
treatment or evaluation for refills of
medications because his or her
symptoms have reached a plateau.
• An individual may not agree to take
prescription medications because the
side effects are less tolerable than the
symptoms.
• An individual may not be able to
afford treatment and may not have
access to free or low-cost medical
services.
• A medical source may have advised
the individual that there is no further
effective treatment to prescribe or
recommend that would benefit the
individual.
• An individual’s symptoms may not
be severe enough to prompt him or her
to seek treatment, or the symptoms may
be relieved with over the counter
medications.
• An individual’s religious beliefs
may prohibit prescribed treatment.
• Due to various limitations (such as
language or mental limitations), an
individual may not understand the
appropriate treatment for or the need for
consistent treatment of his or her
impairment.
• Due to a mental impairment (for
example, individuals with mental
impairments that affect judgment,
reality testing, or orientation), an
individual may not be aware that he or
she has a disorder that requires
treatment.
• A child may disregard the level and
frequency of treatment needed to
E:\FR\FM\16MRN1.SGM
16MRN1
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
mstockstill on DSK4VPTVN1PROD with NOTICES
maintain or improve functioning
because it interferes with his or her
participation in activities typical of
other children his or her age without
impairments.
The above examples illustrate
possible reasons an individual may not
have pursued treatment. However, we
will consider and address reasons for
not pursuing treatment that are
pertinent to an individual’s case. We
will review the case record to determine
whether there are explanations for
inconsistencies in the individual’s
statements about symptoms and their
effects, and whether the evidence of
record supports any of the individual’s
statements at the time he or she made
them. We will explain how we
considered the individual’s reasons in
our evaluation of the individual’s
symptoms.
Adjudication—How We Will Use Our
Evaluation of Symptoms in Our FiveStep Sequential Evaluation Process To
Determine Whether an Individual Is
Disabled
In evaluating an individual’s
symptoms, it is not sufficient for our
adjudicators to make a single,
conclusory statement that ‘‘the
individual’s statements about his or her
symptoms have been considered’’ or
that ‘‘the statements about the
individual’s symptoms are (or are not)
supported or consistent.’’ It is also not
enough for our adjudicators simply to
recite the factors described in the
regulations for evaluating symptoms.
The determination or decision must
contain specific reasons for the weight
given to the individual’s symptoms, be
consistent with and supported by the
evidence, and be clearly articulated so
the individual and any subsequent
reviewer can assess how the adjudicator
evaluated the individual’s symptoms.
Our adjudicators must base their
findings solely on the evidence in the
case record, including any testimony
from the individual or other witnesses
at a hearing before an administrative
law judge or hearing officer. The
subjective statements of the individual
and witnesses obtained at a hearing
should directly relate to symptoms the
individual alleged. Our adjudicators are
prohibited from soliciting additional
non-medical evidence outside of the
record on their own, except as set forth
in our regulations and policies.
Adjudicators must limit their
evaluation to the individual’s
statements about his or her symptoms
and the evidence in the record that is
relevant to the individual’s
impairments. In evaluating an
individual’s symptoms, our adjudicators
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
will not assess an individual’s overall
character or truthfulness in the manner
typically used during an adversarial
court litigation. The focus of the
evaluation of an individual’s symptoms
should not be to determine whether he
or she is a truthful person. Rather, our
adjudicators will focus on whether the
evidence establishes a medically
determinable impairment that could
reasonably be expected to produce the
individual’s symptoms and given the
adjudicator’s evaluation of the
individual’s symptoms, whether the
intensity and persistence of the
symptoms limit the individual’s ability
to perform work-related activities or, for
a child with a title XVI disability claim,
limit the child’s ability to function
independently, appropriately, and
effectively in an age-appropriate
manner.
In determining whether an individual
is disabled or continues to be disabled,
our adjudicators follow a sequential
evaluation process.18 The first step of
our five-step sequential evaluation
process considers whether an individual
is performing substantial gainful
activity. If the individual is performing
substantial gainful activity, we find him
or her not disabled. If the individual is
not performing substantial gainful
activity, we proceed to step 2. We do
not consider symptoms at the first step
of the sequential evaluation process.
At step 2 of the sequential evaluation
process, we determine whether an
individual has a severe medically
determinable physical or mental
impairment or combination of
impairments that has lasted or can be
expected to last for a continuous period
of at least 12 months or end in death.19
A severe impairment is one that affects
an individual’s ability to perform basic
work-related activities for an adult or
that causes more than minimal
functional limitations for a child with a
title XVI disability claim.20 At this step,
we will consider an individual’s
symptoms and functional limitations to
determine whether his or her
impairment(s) is severe unless the
objective medical evidence alone
establishes a severe medically
determinable impairment or
combination of impairments that meets
our duration requirement.21 If an
individual does not have a severe
medically determinable impairment that
18 See 20 CFR 404.1520 and 416.920. For
continuing disability, see 404.1594, 416.994 and
416.994a.
19 See 20 CFR 404.1520(a)(4)(ii) and
416.920(a)(4)(ii).
20 See 20 CFR 416.924(c).
21 See 20 CFR 416.920(c) for adults and
416.924(c) for children.
PO 00000
Frm 00093
Fmt 4703
Sfmt 4703
14171
meets our duration requirement, we will
find the individual not disabled at step
2. If the individual has a severe
medically determinable impairment that
has met or is expected to meet our
duration requirement, we proceed to the
next step.
At step 3 of the sequential evaluation
process, we determine whether an
individual’s impairment(s) meets or
medically equals the severity
requirements of a listed impairment. To
decide whether the impairment meets
the level of severity described in a listed
impairment, we will consider an
individual’s symptoms when a
symptom(s) is one of the criteria in a
listing to ensure the symptom is present
in combination with the other criteria.
If the symptom is not one of the criteria
in a listing, we will not evaluate an
individual’s symptoms at this step as
long as all other findings required by the
specific listing are present. Unless the
listing states otherwise, it is not
necessary to provide information about
the intensity, persistence, or limiting
effects of a symptom as long as all other
findings required by the specific listing
are present.22 In considering whether an
individual’s symptoms, signs, and
laboratory findings are medically equal
to the symptoms, signs, and laboratory
findings of a listed impairment, we will
look to see whether the symptoms,
signs, and laboratory findings are at
least equal in severity to the listed
criteria. However, we will not substitute
the individual’s allegations of pain or
other symptoms for a missing or
deficient sign or laboratory finding to
raise the severity of the impairment(s) to
that of a listed impairment.23 If an
individual’s impairment meets or
medically equals the severity
requirements of a listing, we find him or
her disabled. If an individual’s
impairment does not meet or medically
equal a listing, we proceed to assess the
individual’s residual functional capacity
at step 4 of the sequential evaluation
process unless the individual is a child
with a title XVI disability claim.
For a child with a title XVI disability
claim whose impairment does not meet
or medically equal the severity
requirements of a listing, we consider
whether his or her impairment
functionally equals the listings. This
means that the impairment results in
‘‘marked’’ limitations in two out of six
domains of functioning or an ‘‘extreme’’
limitation in one of the six domains.24
We will evaluate an individual’s
symptoms at this step when we rate
22 See
20 CFR 404.1529(d)(2) and 416.929(d)(2).
20 CFR 404.1529(d)(3) and 416.929(d)(3).
24 See 20 CFR 416.926a.
23 See
E:\FR\FM\16MRN1.SGM
16MRN1
mstockstill on DSK4VPTVN1PROD with NOTICES
14172
Federal Register / Vol. 81, No. 51 / Wednesday, March 16, 2016 / Notices
how a child’s impairment-related
symptoms affect his or her ability to
function independently, appropriately,
and effectively in an age-appropriate
manner in each functional domain. If a
child’s impairment functionally equals a
listing, we find him or her disabled. If
a child’s impairment does not
functionally equal the listings, we find
him or her not disabled. For a child
with a title XVI disability claim, the
sequential evaluation process ends at
this step.
If the individual’s impairment does
not meet or equal a listing, we will
assess and make a finding about an
individual’s residual functional capacity
based on all the relevant medical and
other evidence in the individual’s case
record. An individual’s residual
functional capacity is the most the
individual can still do despite his or her
impairment-related limitations. We
consider the individual’s symptoms
when determining his or her residual
functional capacity and the extent to
which the individual’s impairmentrelated symptoms are consistent with
the evidence in the record.25
After establishing the residual
functional capacity, we determine
whether an individual is able to do any
past relevant work. At step 4, we
compare the individual’s residual
functional capacity with the
requirements of his or her past relevant
work. If the individual’s residual
functional capacity is consistent with
the demands of any of his or her past
relevant work, either as the individual
performed it or as the occupation is
generally performed in the national
economy, then we will find the
individual not disabled. If none of the
individual’s past relevant work is
within his or her residual functional
capacity, we proceed to step 5 of the
sequential evaluation process.
At step 5 of the sequential evaluation
process, we determine whether the
individual is able to adjust to other
work that exists in significant numbers
in the national economy. We consider
the same residual functional capacity,
together with the individual’s age,
education, and past work experience. If
the individual is able to adjust to other
work that exists in significant numbers
in the national economy, we will find
him or her not disabled. If the
individual cannot adjust to other work
that exists in significant numbers in the
national economy, we find him or her
disabled. At step 5 of the sequential
evaluation process, we will not consider
an individual’s symptoms any further
because we considered the individual’s
25 See
20 CFR 404.1545 and 416.945.
VerDate Sep<11>2014
18:11 Mar 15, 2016
Jkt 238001
symptoms when we determined the
individual’s residual functional
capacity.
Effective Date: This SSR is effective
on March 16, 2016.
Cross-References: SSR 96–3p, ‘‘Titles
II and XVI: Considering Allegations of
Pain and Other Symptoms in
Determining Whether a Medically
Determinable Impairment is Severe,’’
SSR 96–8p, ‘‘Titles II and XVI:
Assessing Residual Functional Capacity
in Initial Claims,’’ SSR 96–6p, ‘‘Titles II
and XVI: Consideration of
Administrative Findings of Fact by State
Agency Medical and Psychological
Consultants and Other Program
Physicians and Psychologists at the
Administrative Law Judge and Appeals
Council Levels of Administrative
Review; Medical Equivalence;’’ and
Program Operations Manual System,
sections DI 24515.061 and DI 24515.
064.
[FR Doc. 2016–05916 Filed 3–15–16; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 9483]
International Security Advisory Board
(ISAB) Meeting; Notice Closed Meeting
In accordance with section 10(a)(2) of
the Federal Advisory Committee Act, 5
U.S.C. App 10(a)(2), the Department of
State announces a meeting of the
International Security Advisory Board
(ISAB) to take place on April 27, 2016
at the Department of State, Washington,
DC.
Pursuant to section 10(d) of the
Federal Advisory Committee Act, 5
U.S.C. App 10(d), and 5 U.S.C.
552b(c)(1), it has been determined that
this Board meeting will be closed to the
public because the Board will be
reviewing and discussing matters
properly classified in accordance with
Executive Order 13526. The purpose of
the ISAB is to provide the Department
with a continuing source of
independent advice on all aspects of
arms control, disarmament,
nonproliferation, political-military
affairs, international security, and
related aspects of public diplomacy. The
agenda for this meeting will include
classified discussions related to the
Board’s studies on current U.S. policy
and issues regarding arms control,
international security, nuclear
proliferation, and diplomacy.
For more information, contact
Christopher Herrick, Acting Executive
Director of the International Security
Advisory Board, U.S. Department of
PO 00000
Frm 00094
Fmt 4703
Sfmt 4703
State, Washington, DC 20520,
telephone: (202) 647–9683.
Dated: February 22, 2016.
Christopher Herrick,
Acting Executive Director, International
Security Advisory Board, U.S. Department of
State.
[FR Doc. 2016–05927 Filed 3–15–16; 8:45 am]
BILLING CODE 4710–35–P
SURFACE TRANSPORTATION BOARD
[Docket No. FD 36004]
Canadian Pacific Railway Limited—
Petition for Expedited Declaratory
Order
On March 2, 2016, Canadian Pacific
Railway Limited (CPRL) 1 filed a
petition requesting that the Board issue
a declaratory order on two issues
pertaining to CPRL’s pursuit of a
possible merger with Norfolk Southern
Railway Company (NSR) whether: (1)
‘‘A structure in which CPRL holds its
current rail carrier subsidiaries in an
independent, irrevocable voting trust
while it acquires control of [NSR] and
seeks STB merger authority potentially
could be used to avoid the exercise of
unlawful premature common control’’;
and (2) ‘‘it would be potentially
permissible for the chief executive
officer of [CPRC] to terminate his
position at [CPRC] entities in trust and
then to take the comparable position at
[NSR] pending merger approval.’’ (Pet.
2.) CPRL has requested that the Board
issue an expedited declaratory order by
May 6, 2016.
On March 7, 2016, the Transportation
Communications Union/IAM (TCU/
IAM) requested that the Board provide
interested parties 45 days to reply to the
March 2 petition.2 Also on March 7,
2016, CSX Corporation requested that
the Board deny the March 2 petition, or,
should the Board proceed, issue a
procedural schedule that would allow
parties 30 days from publication to
submit comments and 15 days for the
simultaneous submission of reply
comments. On March 9, 2016, the
Brotherhood of Maintenance of Way
Employes Division/IBT, Brotherhood of
Railroad Signalmen, and International
1 CPRL is a noncarrier, publicly traded holding
company that wholly owns directly or indirectly
rail carriers in Canada and the United States that
do business as ‘‘CP’’ or ‘‘Canadian Pacific.’’ ‘‘CP’’
or ‘‘Canadian Pacific’’ refers to the Canadian Pacific
Railway Company (CPRC), the Canadian operating
company and parent of the U.S. railroad operating
subsidiaries Soo Line Railroad Company, Delaware
and Hudson Railroad Company, and Dakota,
Minnesota and Eastern Railroad Corporation.
2 On March 7, 2016, CPRL filed a reply requesting
that the Board deny TCU/IAM’s extension request.
E:\FR\FM\16MRN1.SGM
16MRN1
]]>Agencies
[Federal Register Volume 81, Number 51 (Wednesday, March 16, 2016)]
[Notices]
[Pages 14166-14172]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-05916]
=======================================================================
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2015-0055]
Social Security Ruling 16-3p; Titles II and XVI: Evaluation of
Symptoms in Disability Claims
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling (SSR).
-----------------------------------------------------------------------
SUMMARY: We are providing notice of SSR 16-3p. This Ruling supersedes
SSR 96-7p. This Ruling provides guidance about how we evaluate
statements regarding the intensity, persistence, and limiting effects
of symptoms in disability claims under Titles II and XVI of the Social
Security Act (Act) and blindness claims under Title XVI of the Act.
DATES: Effective Date: March 16, 2016.
FOR FURTHER INFORMATION CONTACT: Elaine Tocco, Office of Disability
Policy, Social Security Administration, 6401 Security Boulevard,
Baltimore, MD 21235-6401, (410) 966-6356. For information on
eligibility or filing for benefits, call our national toll-free number,
1-800-772-1213 or TTY 1-800-325-0778, or visit our internet site,
Social Security Online, at https://www.socialsecurity.gov.
SUPPLEMENTARY INFORMATION: Although 5 U.S.C. 552(a)(1) and (a)(2) do
not require us to publish this SSR, we are doing so in accordance with
20 CFR 402.35(b)(1).
Through SSRs, we convey to the public SSA precedential decisions
relating to the Federal old age, survivors, disability, supplemental
security income, and special veterans benefits programs. We may base
SSRs
[[Page 14167]]
on determinations or decisions made at all levels of administrative
adjudication, Federal court decisions, Commissioner's decisions,
opinions of the Office of the General Counsel, or other interpretations
of the law and regulations.
Although SSRs do not have the same force and effect as statutes or
regulations, they are binding on all components of the Social Security
Administration. 20 CFR 402.35(b)(1).
This SSR will remain in effect until we publish a notice in the
Federal Register that rescinds it, or we publish a new SSR that
replaces or modifies it.
(Catalog of Federal Domestic Assistance, Programs Nos. 96.001,
Social Security--Disability Insurance; 96.002, Social Security--
Retirement Insurance; 96.004, Social Security--Survivors Insurance;
96.006--Supplemental Security Income.)
Dated: March 9, 2016.
Carolyn W. Colvin,
Acting Commissioner of Social Security.
Policy Interpretation Ruling
Titles II and XVI: Evaluation of Symptoms in Disability Claims
This SSR supersedes SSR 96-7p: Policy Interpretation Ruling Titles
II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the
Credibility of an Individual's Statements.
Purpose:
We are rescinding SSR 96-7p: Policy Interpretation Ruling Titles II
and XVI Evaluation of Symptoms in Disability Claims: Assessing the
Credibility of an Individual's Statements and replacing it with this
Ruling. We solicited a study and recommendations from the
Administrative Conference of the United States (ACUS) on the topic of
symptom evaluation. Based on ACUS's recommendations \1\ and our
adjudicative experience, we are eliminating the use of the term
``credibility'' from our sub-regulatory policy, as our regulations do
not use this term. In doing so, we clarify that subjective symptom
evaluation is not an examination of an individual's character. Instead,
we will more closely follow our regulatory language regarding symptom
evaluation.
---------------------------------------------------------------------------
\1\ ACUS made several recommendations in its March 12, 2015
final report, ``Evaluating Subjective Symptoms in Disability
Claims.'' Among other things, ACUS recommended we consider amending
SSR 96-7p to clarify that subjective symptom evaluation is not an
examination of an individual's character, but rather is an evidence-
based analysis of the administrative record to determine whether the
nature, intensity, frequency, or severity of an individual's
symptoms impact his or her ability to work. In any revised SSR, ACUS
also recommended we more closely follow our regulatory language
about symptom evaluation, which does not use the term
``credibility'' and instead directs adjudicators to consider medical
and other evidence to evaluate the intensity and persistence of
symptoms to determine how the individual's symptoms limit capacity
for work if he or she is an adult, or for a child with a title XVI
disability claim, how symptoms limit ability to function. ACUS
further recommended when revising SSR 96-7p, we offer additional
guidance to adjudicators on regulatory implementation problems that
have been identified since we published SSR 96-7p.
---------------------------------------------------------------------------
Consistent with our regulations, we instruct our adjudicators to
consider all of the evidence in an individual's record when they
evaluate the intensity and persistence of symptoms after they find that
the individual has a medically determinable impairment(s) that could
reasonably be expected to produce those symptoms. We evaluate the
intensity and persistence of an individual's symptoms so we can
determine how symptoms limit ability to perform work-related activities
for an adult and how symptoms limit ability to function independently,
appropriately, and effectively in an age-appropriate manner for a child
with a title XVI disability claim.
Citations (Authority):
Sections 216(i), 223(d), and 1614(a)(3) of the Social Security Act
as amended; Regulations no. 4, sections 404.1508, 404.1512(d),
404.1513, 404.1520, 404.1526, 404.1527, 404.1528, 404.1529, 404.1545
and 404.1594; and Regulations No. 16 sections 416.908, 416.912(d),
416.913, 416.920, 416.924(c), 416.924a(b)(9)(ii-iii), 416.926a,
416.927, 416.928, 416.929, 416.930(c), 416.945, 416.994, and 416.994a.
Background:
In determining whether an individual is disabled, we consider all
of the individual's symptoms, including pain, and the extent to which
the symptoms can reasonably be accepted as consistent with the
objective medical and other evidence in the individual's record. We
define a symptom as the individual's own description or statement of
his or her physical or mental impairment(s).\2\ Under our regulations,
an individual's statements of symptoms alone are not enough to
establish the existence of a physical or mental impairment or
disability. However, if an individual alleges impairment-related
symptoms, we must evaluate those symptoms using a two-step process set
forth in our regulations.\3\
---------------------------------------------------------------------------
\2\ See 20 CFR 404.1528(a) and 416.928(a) for how our
regulations define symptoms.
\3\ See 20 CFR 404.1529 and 416.929 for how we evaluate
statements of symptoms.
---------------------------------------------------------------------------
First, we must consider whether there is an underlying medically
determinable physical or mental impairment(s) that could reasonably be
expected to produce an individual's symptoms, such as pain. Second,
once an underlying physical or mental impairment(s) that could
reasonably be expected to produce an individual's symptoms is
established, we evaluate the intensity and persistence of those
symptoms to determine the extent to which the symptoms limit an
individual's ability to perform work-related activities for an adult or
to function independently, appropriately, and effectively in an age-
appropriate manner for a child with a title XVI disability claim.
This ruling clarifies how we consider:
The intensity, persistence, and functionally limiting
effects of symptoms,
Objective medical evidence when evaluating symptoms,
Other evidence when evaluating symptoms,
The factors set forth in 20 CFR 404.1529(c)(3) and
416.929(c)(3),
The extent to which an individual's symptoms affect his or
her ability to perform work-related activities or function
independently, appropriately, and effectively in an age-appropriate
manner for a child with a title XVI disability claim, and
Adjudication standards for evaluating symptoms in the
sequential evaluation process.
Policy Interpretation:
We use a two-step process for evaluating an individual's symptoms.
The two-step process:
Step 1: We Determine Whether the Individual Has a Medically
Determinable Impairment (MDI) That Could Reasonably be Expected To
Produce the Individual's Alleged Symptoms
An individual's symptoms, such as pain, fatigue, shortness of
breath, weakness, nervousness, or periods of poor concentration will
not be found to affect the ability to perform work-related activities
for an adult or to function independently, appropriately, and
effectively in an age-appropriate manner for a child with a title XVI
disability claim unless medical signs or laboratory findings show a
medically determinable impairment is present. Signs are anatomical,
physiological, or psychological abnormalities established by medically
acceptable clinical diagnostic techniques that can be observed apart
from an individual's symptoms.\4\ Laboratory findings are anatomical,
physiological, or psychological phenomena, which can be shown by the
use of medically
[[Page 14168]]
acceptable laboratory diagnostic techniques.\5\ We call the medical
evidence that provides signs or laboratory findings objective medical
evidence. We must have objective medical evidence from an acceptable
medical source \6\ to establish the existence of a medically
determinable impairment that could reasonably be expected to produce an
individual's alleged symptoms.\7\
---------------------------------------------------------------------------
\4\ See 20 CFR 404.1528(b) and 416.928(b) for how our
regulations define signs.
\5\ See 20 CFR 404.1528(c) and 416.928(c) for how our
regulations define laboratory findings.
\6\ See 20 CFR 404.1513(a) and 416.913(a) for a list of
acceptable medical sources.
\7\ See 20 CFR 404.1508 and 416.908 for what is needed to show a
medically determinable impairment.
---------------------------------------------------------------------------
In determining whether there is an underlying medically
determinable impairment that could reasonably be expected to produce an
individual's symptoms, we do not consider whether the severity of an
individual's alleged symptoms is supported by the objective medical
evidence. For example, if an individual has a medically determinable
impairment established by a knee x-ray showing mild degenerative
changes and he or she alleges extreme pain that limits his or her
ability to stand and walk, we will find that individual has a medically
determinable impairment that could reasonably be expected to produce
the symptom of pain. We will proceed to step two of the two-step
process, even though the level of pain an individual alleges may seem
out of proportion with the objective medical evidence.
In some instances, the objective medical evidence clearly
establishes that an individual's symptoms are due to a medically
determinable impairment. At other times, we may have insufficient
evidence to determine whether an individual has a medically
determinable impairment that could potentially account for his or her
alleged symptoms. In those instances, we develop evidence regarding a
potential medically determinable impairment using a variety of means
set forth in our regulations. For example, we may obtain additional
information from the individual about the nature of his or her symptoms
and their effect on functioning. We may request additional information
from the individual about other testing or treatment he or she may have
undergone for the symptoms. We may request clarifying information from
an individual's medical sources, or we may send an individual to a
consultative examination that may include diagnostic testing. We may
use our agency experts to help us determine whether an individual's
medically determinable impairment could reasonably be expected to
produce his or her symptoms. At the administrative law judge hearing
level or the Appeals Council level of the administrative review
process, we may ask for and consider evidence from a medical or
psychological expert to help us determine whether an individual's
medically determinable impairment could reasonably be expected to
produce his or her symptoms. If an individual alleges symptoms, but the
medical signs and laboratory findings do not substantiate any medically
determinable impairment capable of producing the individual's alleged
symptoms, we will not evaluate the individual's symptoms at step two of
our two-step evaluation process.
We will not find an individual disabled based on alleged symptoms
alone. If there is no medically determinable impairment, or if there is
a medically determinable impairment, but the impairment(s) could not
reasonably be expected to produce the individual's symptoms, we will
not find those symptoms affect the ability to perform work-related
activities for an adult or ability to function independently,
appropriately, and effectively in an age-appropriate manner for a child
with a title XVI disability claim.
Step 2: We Evaluate the Intensity and Persistence of an Individual's
Symptoms Such as Pain and Determine the Extent to Which an Individual's
Symptoms Limit His or Her Ability To Perform Work-Related Activities
for an Adult or To Function Independently, Appropriately, and
Effectively in an Age-Appropriate Manner for a Child With a Title XVI
Disability Claim
Once the existence of a medically determinable impairment that
could reasonably be expected to produce pain or other symptoms is
established, we recognize that some individuals may experience symptoms
differently and may be limited by symptoms to a greater or lesser
extent than other individuals with the same medical impairments, the
same objective medical evidence, and the same non-medical evidence. In
considering the intensity, persistence, and limiting effects of an
individual's symptoms, we examine the entire case record, including the
objective medical evidence; an individual's statements about the
intensity, persistence, and limiting effects of symptoms; statements
and other information provided by medical sources and other persons;
and any other relevant evidence in the individual's case record.
We will not evaluate an individual's symptoms without making every
reasonable effort to obtain a complete medical history \8\ unless the
evidence supports a finding that the individual is disabled. We will
not evaluate an individual's symptoms based solely on objective medical
evidence unless that objective medical evidence supports a finding that
the individual is disabled. We will evaluate an individual's symptoms
based on the evidence in an individual's record as described below;
however, not all of the types of evidence described below will be
available or relevant in every case.
---------------------------------------------------------------------------
\8\ By ``complete medical history,'' we mean the individual's
complete medical history for at least the 12 months preceding the
month in which he or she filed an application, unless there is a
reason to believe that development of an earlier period is necessary
or the individual says that his or her alleged disability began less
than 12 months before he or she filed an application. 20 CFR
404.1512(d) and 416.912(d).
---------------------------------------------------------------------------
1. Consideration of Objective Medical Evidence
Symptoms cannot always be measured objectively through clinical or
laboratory diagnostic techniques. However, objective medical evidence
is a useful indicator to help make reasonable conclusions about the
intensity and persistence of symptoms, including the effects those
symptoms may have on the ability to perform work-related activities for
an adult or to function independently, appropriately, and effectively
in an age-appropriate manner for a child with a title XVI claim.\9\ We
must consider whether an individual's statements about the intensity,
persistence, and limiting effects of his or her symptoms are consistent
with the medical signs and laboratory findings of record.
---------------------------------------------------------------------------
\9\ See 20 CFR 404.1529(c)(2) and 416.929(c)(2).
---------------------------------------------------------------------------
The intensity, persistence, and limiting effects of many symptoms
can be clinically observed and recorded in the medical evidence.
Examples such as reduced joint motion, muscle spasm, sensory deficit,
and motor disruption illustrate findings that may result from, or be
associated with, the symptom of pain.\10\ These findings may be
consistent with an individual's statements about symptoms and their
functional effects. However, when the results of tests are not
consistent with other evidence in the record, they may be less
supportive of an individual's statements about pain or other symptoms
than test results and statements that are consistent with other
evidence in the record.
---------------------------------------------------------------------------
\10\ See 20 CFR 404.1529(c)(2) and 416.929(c)(2).
---------------------------------------------------------------------------
For example, an individual with reduced muscle strength testing who
indicates that for the last year pain has limited his or her standing
and walking
[[Page 14169]]
to no more than a few minutes a day would be expected to have some
signs of muscle wasting as a result. If no muscle wasting were present,
we might not, depending on the other evidence in the record, find the
individual's reduced muscle strength on clinical testing to be
consistent with the individual's alleged impairment-related symptoms.
However, we will not disregard an individual's statements about the
intensity, persistence, and limiting effects of symptoms solely because
the objective medical evidence does not substantiate the degree of
impairment-related symptoms alleged by the individual.\11\ A report of
minimal or negative findings or inconsistencies in the objective
medical evidence is one of the many factors we must consider in
evaluating the intensity, persistence, and limiting effects of an
individual's symptoms.
---------------------------------------------------------------------------
\11\ See 20 CFR 404.1529 and 416.929.
---------------------------------------------------------------------------
2. Consideration of Other Evidence
If we cannot make a disability determination or decision that is
fully favorable based solely on objective medical evidence, then we
carefully consider other evidence in the record in reaching a
conclusion about the intensity, persistence, and limiting effects of an
individual's symptoms. Other evidence that we will consider includes
statements from the individual, medical sources, and any other sources
that might have information about the individual's symptoms, including
agency personnel, as well as the factors set forth in our
regulations.\12\ For example, for a child with a title XVI disability
claim, we will consider evidence submitted from educational agencies
and personnel, statements from parents and other relatives, and
evidence submitted by social welfare agencies, therapists, and other
practitioners.\13\
---------------------------------------------------------------------------
\12\ See 20 CFR 404.1513 and 416.913.
\13\ See 20 CFR 404.1529(c)(3) and 416.929(c)(3).
---------------------------------------------------------------------------
a. The Individual
An individual may make statements about the intensity, persistence,
and limiting effects of his or her symptoms. If a child with a title
XVI disability claim is unable to describe his or her symptoms
adequately, we will accept a description of his or her symptoms from
the person most familiar with the child, such as a parent, another
relative, or a guardian.\14\ For an adult whose impairment prevents him
or her from describing symptoms adequately, we may also consider a
description of his or her symptoms from a person who is familiar with
the individual.
---------------------------------------------------------------------------
\14\ See 20 CFR 416.928(a).
---------------------------------------------------------------------------
An individual may make statements about symptoms directly to
medical sources, other sources, or he or she may make them directly to
us. An individual may have made statements about symptoms in connection
with claims for other types of disability benefits such as workers'
compensation, benefits under programs of the Department of Veterans
Affairs, or private insurance benefits.
An individual's statements may address the frequency and duration
of the symptoms, the location of the symptoms, and the impact of the
symptoms on the ability to perform daily living activities. An
individual's statements may also include activities that precipitate or
aggravate the symptoms, medications and treatments used, and other
methods used to alleviate the symptoms. We will consider an
individual's statements about the intensity, persistence, and limiting
effects of symptoms, and we will evaluate whether the statements are
consistent with objective medical evidence and the other evidence.
b. Medical Sources
Medical sources may offer diagnoses, prognoses, and opinions as
well as statements and medical reports about an individual's history,
treatment, responses to treatment, prior work record, efforts to work,
daily activities, and other information concerning the intensity,
persistence, and limiting effects of an individual's symptoms.
Important information about symptoms recorded by medical sources
and reported in the medical evidence may include, but is not limited
to, the following:
Onset, description of the character and location of the
symptoms, precipitating and aggravating factors, frequency and
duration, change over a period of time (e.g., whether worsening,
improving, or static), and daily activities. Very often, the individual
has provided this information to the medical source, and the
information may be compared with the individual's other statements in
the case record. In addition, the evidence provided by a medical source
may contain medical opinions about the individual's symptoms and their
effects. Our adjudicators will weigh such opinions by applying the
factors in 20 CFR 404.1527 and 416.927.
A longitudinal record of any treatment and its success or
failure, including any side effects of medication.
Indications of other impairments, such as potential mental
impairments, that could account for an individual's allegations.
Medical evidence from medical sources that have not treated or
examined the individual is also important in the adjudicator's
evaluation of an individual's statements about pain or other symptoms.
For example, State agency medical and psychological consultants and
other program physicians and psychologists may offer findings about the
existence and severity of an individual's symptoms. We will consider
these findings in evaluating the intensity, persistence, and limiting
effects of the individual's symptoms. Adjudicators at the hearing level
or at the Appeals Council level must consider the findings from these
medical sources even though they are not bound by them.\15\
---------------------------------------------------------------------------
\15\ See 20 CFR 404.1527 and 416.927.
---------------------------------------------------------------------------
c. Non-Medical Sources
Other sources may provide information from which we may draw
inferences and conclusions about an individual's statements that would
be helpful to us in assessing the intensity, persistence, and limiting
effects of symptoms. Examples of such sources include public and
private agencies, other practitioners, educational personnel, non-
medical sources such as family and friends, and agency personnel. We
will consider any statements in the record noted by agency personnel
who previously interviewed the individual, whether in person or by
telephone. The adjudicator will consider any personal observations of
the individual in terms of how consistent those observations are with
the individual's statements about his or her symptoms as well as with
all of the evidence in the file.
d. Factors To Consider In Evaluating the Intensity, Persistence and
Limiting Effects of an Individual's Symptoms
In addition to using all of the evidence to evaluate the intensity,
persistence, and limiting effects of an individual's symptoms, we will
also use the factors set forth in 20 CFR 404.1529(c)(3) and
416.929(c)(3). These factors include:
1. Daily activities;
2. The location, duration, frequency, and intensity of pain or
other symptoms;
3. Factors that precipitate and aggravate the symptoms;
4. The type, dosage, effectiveness, and side effects of any
medication an individual takes or has taken to alleviate pain or other
symptoms;
[[Page 14170]]
5. Treatment, other than medication, an individual receives or has
received for relief of pain or other symptoms;
6. Any measures other than treatment an individual uses or has used
to relieve pain or other symptoms (e.g., lying flat on his or her back,
standing for 15 to 20 minutes every hour, or sleeping on a board); and
7. Any other factors concerning an individual's functional
limitations and restrictions due to pain or other symptoms.
We will consider other evidence to evaluate only the factors that
are relevant to assessing the intensity, persistence, and limiting
effects of the individual's symptoms. If there is no information in the
evidence of record regarding one of the factors, we will not discuss
that specific factor in the determination or decision because it is not
relevant to the case. We will discuss the factors pertinent to the
evidence of record.
How We Will Determine if an Individual's Symptoms Affect the Ability To
Perform Work-Related Activities for an Adult, or Age-Appropriate
Activities for a Child With a Title XVI Disability Claim
If an individual's statements about the intensity, persistence, and
limiting effects of symptoms are consistent with the objective medical
evidence and the other evidence of record, we will determine that the
individual's symptoms are more likely to reduce his or her capacities
to perform work-related activities for an adult or reduce a child's
ability to function independently, appropriately, and effectively in an
age-appropriate manner for a child with a title XVI disability
claim.\16\ In contrast, if an individual's statements about the
intensity, persistence, and limiting effects of symptoms are
inconsistent with the objective medical evidence and the other
evidence, we will determine that the individual's symptoms are less
likely to reduce his or her capacities to perform work-related
activities or abilities to function independently, appropriately, and
effectively in an age-appropriate manner.
---------------------------------------------------------------------------
\16\ See 20 CFR 404.1529(c)(4) and 416.929(c)(4).
---------------------------------------------------------------------------
We may or may not find an individual's symptoms and related
limitations consistent with the evidence in his or her record. We will
explain which of an individual's symptoms we found consistent or
inconsistent with the evidence in his or her record and how our
evaluation of the individual's symptoms led to our conclusions. We will
evaluate an individual's symptoms considering all the evidence in his
or her record.
In determining whether an individual's symptoms will reduce his or
her corresponding capacities to perform work-related activities or
abilities to function independently, appropriately, and effectively in
an age-appropriate manner, we will consider the consistency of the
individual's own statements. To do so, we will compare statements an
individual makes in connection with the individual's claim for
disability benefits with any existing statements the individual made
under other circumstances.
We will consider statements an individual made to us at each prior
step of the administrative review process, as well as statements the
individual made in any subsequent or prior disability claims under
titles II and XVI. If an individual's various statements about the
intensity, persistence, and limiting effects of symptoms are consistent
with one another and consistent with the objective medical evidence and
other evidence in the record, we will determine that an individual's
symptoms are more likely to reduce his or her capacities for work-
related activities or reduce the abilities to function independently,
appropriately, and effectively in an age-appropriate manner. However,
inconsistencies in an individual's statements made at varying times
does not necessarily mean they are inaccurate. Symptoms may vary in
their intensity, persistence, and functional effects, or may worsen or
improve with time. This may explain why an individual's statements vary
when describing the intensity, persistence, or functional effects of
symptoms.
We will consider an individual's attempts to seek medical treatment
for symptoms and to follow treatment once it is prescribed when
evaluating whether symptom intensity and persistence affect the ability
to perform work-related activities for an adult or the ability to
function independently, appropriately, and effectively in an age-
appropriate manner for a child with a title XVI disability claim.
Persistent attempts to obtain relief of symptoms, such as increasing
dosages and changing medications, trying a variety of treatments,
referrals to specialists, or changing treatment sources may be an
indication that an individual's symptoms are a source of distress and
may show that they are intense and persistent.\17\
---------------------------------------------------------------------------
\17\ See 20 CFR 404.1529(c) and 416.929(c).
---------------------------------------------------------------------------
In contrast, if the frequency or extent of the treatment sought by
an individual is not comparable with the degree of the individual's
subjective complaints, or if the individual fails to follow prescribed
treatment that might improve symptoms, we may find the alleged
intensity and persistence of an individual's symptoms are inconsistent
with the overall evidence of record. We will not find an individual's
symptoms inconsistent with the evidence in the record on this basis
without considering possible reasons he or she may not comply with
treatment or seek treatment consistent with the degree of his or her
complaints. We may need to contact the individual regarding the lack of
treatment or, at an administrative proceeding, ask why he or she has
not complied with or sought treatment in a manner consistent with his
or her complaints. When we consider the individual's treatment history,
we may consider (but are not limited to) one or more of the following:
An individual may have structured his or her activities to
minimize symptoms to a tolerable level by avoiding physical activities
or mental stressors that aggravate his or her symptoms.
An individual may receive periodic treatment or evaluation
for refills of medications because his or her symptoms have reached a
plateau.
An individual may not agree to take prescription
medications because the side effects are less tolerable than the
symptoms.
An individual may not be able to afford treatment and may
not have access to free or low-cost medical services.
A medical source may have advised the individual that
there is no further effective treatment to prescribe or recommend that
would benefit the individual.
An individual's symptoms may not be severe enough to
prompt him or her to seek treatment, or the symptoms may be relieved
with over the counter medications.
An individual's religious beliefs may prohibit prescribed
treatment.
Due to various limitations (such as language or mental
limitations), an individual may not understand the appropriate
treatment for or the need for consistent treatment of his or her
impairment.
Due to a mental impairment (for example, individuals with
mental impairments that affect judgment, reality testing, or
orientation), an individual may not be aware that he or she has a
disorder that requires treatment.
A child may disregard the level and frequency of treatment
needed to
[[Page 14171]]
maintain or improve functioning because it interferes with his or her
participation in activities typical of other children his or her age
without impairments.
The above examples illustrate possible reasons an individual may
not have pursued treatment. However, we will consider and address
reasons for not pursuing treatment that are pertinent to an
individual's case. We will review the case record to determine whether
there are explanations for inconsistencies in the individual's
statements about symptoms and their effects, and whether the evidence
of record supports any of the individual's statements at the time he or
she made them. We will explain how we considered the individual's
reasons in our evaluation of the individual's symptoms.
Adjudication--How We Will Use Our Evaluation of Symptoms in Our Five-
Step Sequential Evaluation Process To Determine Whether an Individual
Is Disabled
In evaluating an individual's symptoms, it is not sufficient for
our adjudicators to make a single, conclusory statement that ``the
individual's statements about his or her symptoms have been
considered'' or that ``the statements about the individual's symptoms
are (or are not) supported or consistent.'' It is also not enough for
our adjudicators simply to recite the factors described in the
regulations for evaluating symptoms. The determination or decision must
contain specific reasons for the weight given to the individual's
symptoms, be consistent with and supported by the evidence, and be
clearly articulated so the individual and any subsequent reviewer can
assess how the adjudicator evaluated the individual's symptoms.
Our adjudicators must base their findings solely on the evidence in
the case record, including any testimony from the individual or other
witnesses at a hearing before an administrative law judge or hearing
officer. The subjective statements of the individual and witnesses
obtained at a hearing should directly relate to symptoms the individual
alleged. Our adjudicators are prohibited from soliciting additional
non-medical evidence outside of the record on their own, except as set
forth in our regulations and policies.
Adjudicators must limit their evaluation to the individual's
statements about his or her symptoms and the evidence in the record
that is relevant to the individual's impairments. In evaluating an
individual's symptoms, our adjudicators will not assess an individual's
overall character or truthfulness in the manner typically used during
an adversarial court litigation. The focus of the evaluation of an
individual's symptoms should not be to determine whether he or she is a
truthful person. Rather, our adjudicators will focus on whether the
evidence establishes a medically determinable impairment that could
reasonably be expected to produce the individual's symptoms and given
the adjudicator's evaluation of the individual's symptoms, whether the
intensity and persistence of the symptoms limit the individual's
ability to perform work-related activities or, for a child with a title
XVI disability claim, limit the child's ability to function
independently, appropriately, and effectively in an age-appropriate
manner.
In determining whether an individual is disabled or continues to be
disabled, our adjudicators follow a sequential evaluation process.\18\
The first step of our five-step sequential evaluation process considers
whether an individual is performing substantial gainful activity. If
the individual is performing substantial gainful activity, we find him
or her not disabled. If the individual is not performing substantial
gainful activity, we proceed to step 2. We do not consider symptoms at
the first step of the sequential evaluation process.
---------------------------------------------------------------------------
\18\ See 20 CFR 404.1520 and 416.920. For continuing disability,
see 404.1594, 416.994 and 416.994a.
---------------------------------------------------------------------------
At step 2 of the sequential evaluation process, we determine
whether an individual has a severe medically determinable physical or
mental impairment or combination of impairments that has lasted or can
be expected to last for a continuous period of at least 12 months or
end in death.\19\ A severe impairment is one that affects an
individual's ability to perform basic work-related activities for an
adult or that causes more than minimal functional limitations for a
child with a title XVI disability claim.\20\ At this step, we will
consider an individual's symptoms and functional limitations to
determine whether his or her impairment(s) is severe unless the
objective medical evidence alone establishes a severe medically
determinable impairment or combination of impairments that meets our
duration requirement.\21\ If an individual does not have a severe
medically determinable impairment that meets our duration requirement,
we will find the individual not disabled at step 2. If the individual
has a severe medically determinable impairment that has met or is
expected to meet our duration requirement, we proceed to the next step.
---------------------------------------------------------------------------
\19\ See 20 CFR 404.1520(a)(4)(ii) and 416.920(a)(4)(ii).
\20\ See 20 CFR 416.924(c).
\21\ See 20 CFR 416.920(c) for adults and 416.924(c) for
children.
---------------------------------------------------------------------------
At step 3 of the sequential evaluation process, we determine
whether an individual's impairment(s) meets or medically equals the
severity requirements of a listed impairment. To decide whether the
impairment meets the level of severity described in a listed
impairment, we will consider an individual's symptoms when a symptom(s)
is one of the criteria in a listing to ensure the symptom is present in
combination with the other criteria. If the symptom is not one of the
criteria in a listing, we will not evaluate an individual's symptoms at
this step as long as all other findings required by the specific
listing are present. Unless the listing states otherwise, it is not
necessary to provide information about the intensity, persistence, or
limiting effects of a symptom as long as all other findings required by
the specific listing are present.\22\ In considering whether an
individual's symptoms, signs, and laboratory findings are medically
equal to the symptoms, signs, and laboratory findings of a listed
impairment, we will look to see whether the symptoms, signs, and
laboratory findings are at least equal in severity to the listed
criteria. However, we will not substitute the individual's allegations
of pain or other symptoms for a missing or deficient sign or laboratory
finding to raise the severity of the impairment(s) to that of a listed
impairment.\23\ If an individual's impairment meets or medically equals
the severity requirements of a listing, we find him or her disabled. If
an individual's impairment does not meet or medically equal a listing,
we proceed to assess the individual's residual functional capacity at
step 4 of the sequential evaluation process unless the individual is a
child with a title XVI disability claim.
---------------------------------------------------------------------------
\22\ See 20 CFR 404.1529(d)(2) and 416.929(d)(2).
\23\ See 20 CFR 404.1529(d)(3) and 416.929(d)(3).
---------------------------------------------------------------------------
For a child with a title XVI disability claim whose impairment does
not meet or medically equal the severity requirements of a listing, we
consider whether his or her impairment functionally equals the
listings. This means that the impairment results in ``marked''
limitations in two out of six domains of functioning or an ``extreme''
limitation in one of the six domains.\24\ We will evaluate an
individual's symptoms at this step when we rate
[[Page 14172]]
how a child's impairment-related symptoms affect his or her ability to
function independently, appropriately, and effectively in an age-
appropriate manner in each functional domain. If a child's impairment
functionally equals a listing, we find him or her disabled. If a
child's impairment does not functionally equal the listings, we find
him or her not disabled. For a child with a title XVI disability claim,
the sequential evaluation process ends at this step.
---------------------------------------------------------------------------
\24\ See 20 CFR 416.926a.
---------------------------------------------------------------------------
If the individual's impairment does not meet or equal a listing, we
will assess and make a finding about an individual's residual
functional capacity based on all the relevant medical and other
evidence in the individual's case record. An individual's residual
functional capacity is the most the individual can still do despite his
or her impairment-related limitations. We consider the individual's
symptoms when determining his or her residual functional capacity and
the extent to which the individual's impairment-related symptoms are
consistent with the evidence in the record.\25\
---------------------------------------------------------------------------
\25\ See 20 CFR 404.1545 and 416.945.
---------------------------------------------------------------------------
After establishing the residual functional capacity, we determine
whether an individual is able to do any past relevant work. At step 4,
we compare the individual's residual functional capacity with the
requirements of his or her past relevant work. If the individual's
residual functional capacity is consistent with the demands of any of
his or her past relevant work, either as the individual performed it or
as the occupation is generally performed in the national economy, then
we will find the individual not disabled. If none of the individual's
past relevant work is within his or her residual functional capacity,
we proceed to step 5 of the sequential evaluation process.
At step 5 of the sequential evaluation process, we determine
whether the individual is able to adjust to other work that exists in
significant numbers in the national economy. We consider the same
residual functional capacity, together with the individual's age,
education, and past work experience. If the individual is able to
adjust to other work that exists in significant numbers in the national
economy, we will find him or her not disabled. If the individual cannot
adjust to other work that exists in significant numbers in the national
economy, we find him or her disabled. At step 5 of the sequential
evaluation process, we will not consider an individual's symptoms any
further because we considered the individual's symptoms when we
determined the individual's residual functional capacity.
Effective Date: This SSR is effective on March 16, 2016.
Cross-References: SSR 96-3p, ``Titles II and XVI: Considering
Allegations of Pain and Other Symptoms in Determining Whether a
Medically Determinable Impairment is Severe,'' SSR 96-8p, ``Titles II
and XVI: Assessing Residual Functional Capacity in Initial Claims,''
SSR 96-6p, ``Titles II and XVI: Consideration of Administrative
Findings of Fact by State Agency Medical and Psychological Consultants
and Other Program Physicians and Psychologists at the Administrative
Law Judge and Appeals Council Levels of Administrative Review; Medical
Equivalence;'' and Program Operations Manual System, sections DI
24515.061 and DI 24515. 064.
[FR Doc. 2016-05916 Filed 3-15-16; 8:45 am]
BILLING CODE 4191-02-P
