Social Security Ruling 16-3p Titles II And XVI: Evaluation Of Symptoms In Disability Claims, 49462-49468 [2017-23143]

Agencies

• Social Security Administration

[Federal Register Volume 82, Number 205 (Wednesday, October 25, 2017)]
[Notices]
[Pages 49462-49468]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-23143]


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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).

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SUMMARY: We are republishing SSR 16-3p, a ruling that rescinded and 
superseded SSR 96-7p, with a revision detailing how we apply the SSR as 
it relates to the applicable date. We changed our terminology from 
``effective date'' to ``applicable date'' based on guidance from the 
Office of the Federal Register. We also updated citations to reflect 
the revised regulations that became effective on March 27, 2017. This 
Ruling is otherwise unchanged, and 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.

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 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.
    This SSR, republished in its entirety, includes a revision to 
clarify that our adjudicators will apply SSR 16-3p when we make 
determinations and decisions on or after March 28, 2016. When a Federal 
court reviews our final decision in a claim, we also explain that we 
expect the court to review the final

[[Page 49463]]

decision using the rules that were in effect at the time we issued the 
decision under review. If a court remands a claim for further 
proceedings after the applicable date of the ruling (March 28, 2016), 
we will apply SSR 16-3p to the entire period in the decision we make 
after the court's remand.

(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.)

Nancy A. Berryhill,
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.
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    \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.
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    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 404.1502, 404.1512(d), 
404.1513, 404.1520, 404.1520c, 404.1521, 404.1526, 404.1527, 404.1529, 
404.1545 and 404.1594; and Regulations No. 16 sections 416.902, 
416.912(d), 416.913, 416.920, 416.920c, 416.921, 416.924(c), 
416.924a(b)(9)(ii-iii), 416.926a, 416.927, 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\
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    \2\ See 20 CFR 404.1502(i) and 416.902(n) for how our 
regulations define symptoms.
    \3\ See 20 CFR 404.1529 and 416.929 for how we evaluate 
statements of symptoms.
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    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 acceptable laboratory diagnostic techniques.\5\ We 
call the medical

[[Page 49464]]

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\
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    \4\ See 20 CFR 404.1502(g) and 416.902(l) for how our 
regulations define signs.
    \5\ See 20 CFR 404.1502(c) and 416.902(g) for how our 
regulations define laboratory findings.
    \6\ See 20 CFR 404.1502(a) and 416.902(a) for a list of 
acceptable medical sources.
    \7\ See 20 CFR 404.1521 and 416.921 for what is needed to show a 
medically determinable impairment.
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    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.
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    \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(b)(ii) and 416.912(b)(ii).
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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.
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    \9\ See 20 CFR 404.1529(c)(2) and 416.929(c)(2).
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    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.
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    \10\ See 20 CFR 404.1529(c)(2) and 416.929(c)(2).
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    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 to no more than a few minutes a day

[[Page 49465]]

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.
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    \11\ See 20 CFR 404.1529 and 416.929.
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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\
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    \12\ See 20 CFR 404.1513 and 416.913.
    \13\ See 20 CFR 404.1529(c)(3) and 416.929(c)(3)
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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.
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    \14\ See 20 CFR 416.924a(a)(2).
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    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 consider such opinions by applying the 
factors in 20 CFR 404.1520c and 416.920c.\15\
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    \15\ For claims filed before March 27, 2017, our adjudicators 
will apply the rules in 20 CFR 404.1527 and 416.927.
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     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.\16\
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    \16\ See 20 C.F.R. 404.1520c and 416.902c for claims filed on or 
after March 27, 2017. See 20 CFR 404.1527 and 416.927 for claims 
filed before March 27, 2017.
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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;

[[Page 49466]]

    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;
    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.\17\ 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.
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    \17\ See 20 CFR 404.1529(c)(4) and 416.929(c)(4).
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    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.\18\
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    \18\ See 20 CFR 404.1529(c) and 416.929(c).
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    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,

[[Page 49467]]

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 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.\19\ 
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.
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    \19\ See 20 CFR 404.1520 and 416.920. For continuing disability, 
see 404.1594, 416.994 and 416.994a.
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    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.\20\ 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.\21\ 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.\22\ 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.
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    \20\ See 20 CFR 404.1520(a)(4)(ii) and 416.920(a)(4)(ii).
    \21\ See 20 CFR 416.924(c).
    \22\ See 20 CFR 416.920(c) for adults and 416.924(c) for 
children.
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    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.\23\ 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.\24\ 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.
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    \23\ See 20 CFR 404.1529(d)(2) and 416.929(d)(2).
    \24\ See 20 CFR 404.1529(d)(3) and 416.929(d)(3).
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    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

[[Page 49468]]

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.\25\ We will evaluate an individual's symptoms at this 
step when we rate 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.
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    \25\ See 20 CFR 416.926a.
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    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.\26\
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    \26\ See 20 CFR 404.1545 and 416.945.
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    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.

This SSR is applicable on MARCH 28, 2016.\27\
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    \27\ Our adjudicators will apply this ruling when we make 
determinations and decisions on or after March 28, 2016. When a 
Federal court reviews our final decision in a claim, we expect the 
court will review the final decision using the rules that were in 
effect at the time we issued the decision under review. If a court 
finds reversible error and remands a case for further administrative 
proceedings after March 28, 2016, the applicable date of this 
ruling, we will apply this ruling to the entire period at issue in 
the decision we make after the court's remand. Our regulations on 
evaluating symptoms are unchanged.

    CROSS-REFERENCES: SSR 96-8p, ``Titles II and XVI: Assessing 
Residual Functional Capacity in Initial Claims,'' and Program 
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Operations Manual System, section DI 24515.064.

[FR Doc. 2017-23143 Filed 10-24-17; 8:45 am]
 BILLING CODE 4191-02-P