Social Security Ruling, SSR 19-2p; Titles II and XVI: Evaluating Cases Involving Obesity, 22924-22926 [2019-10432]
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Federal Register / Vol. 84, No. 97 / Monday, May 20, 2019 / Notices
SOCIAL SECURITY ADMINISTRATION
Social Security—Survivors Insurance;
96.006, Supplemental Security Income.)
[Docket No. SSA–2018–0022]
Nancy A. Berryhill,
Acting Commissioner of Social Security.
Social Security Ruling, SSR 19–2p;
Titles II and XVI: Evaluating Cases
Involving Obesity
AGENCY:
ACTION:
Policy Interpretation Ruling
Social Security Administration.
Notice of Social Security Ruling
(SSR).
We are providing notice of
SSR 19–2p. This SSR provides guidance
on how we establish that a person has
a medically determinable impairment of
obesity and how we evaluate obesity in
disability claims under Titles II and XVI
of the Social Security Act.
SUMMARY:
We will apply this notice on May
20, 2019.
DATES:
FOR FURTHER INFORMATION CONTACT:
Cheryl A. Williams, Office of Disability
Policy, Social Security Administration,
6401 Security Boulevard, Baltimore,
Maryland 21235–6401, (410) 965–1020.
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.
Although
5 U.S.C. 552(a)(1) and (a)(2) do not
require us to publish this SSR, we are
doing so under 20 CFR 402.35(b)(1).
Through SSRs, we make available to
the public 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 of
our components. 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 until we
publish a new SSR that replaces or
modifies it.
khammond on DSKBBV9HB2PROD with NOTICES
SUPPLEMENTARY INFORMATION:
(Catalog of Federal Domestic Assistance,
Program Nos. 96.001, Social Security—
Disability Insurance; 96.002, Social
Security—Retirement Insurance; 96.004,
VerDate Sep<11>2014
16:41 May 17, 2019
Jkt 247001
Titles II and XVI: Evaluating Cases
Involving Obesity
This Social Security Ruling (SSR)
rescinds and replaces SSR 02–1p; Titles
II and XVI: Evaluation of Obesity.
Purpose: This SSR provides guidance
on how we establish that a person has
a medically determinable impairment
(MDI) of obesity and how we evaluate
obesity in disability claims under Titles
II and XVI of the Social Security Act
(Act).1
Citations (Authority): Sections 216(i),
223(d), 223(f), 1614(a), and 1614(c) of
the Act, as amended; Regulations No. 4,
subpart P, sections 404.1502, 404.1509,
404.1512, 404.1513, 404.1520,
404.1521–404.1523, 404.1525, 404.1526,
404.1529, 404.1545, 404.1546,
404.1560–404.1569a, 404.1594 and
appendices 1 and 2; Regulations No. 16,
subpart I, sections 416.902, 416.909,
416.912, 416.913, 416.920, 416.921–
416.923, 416.924, 416.924a, 416.925,
416.926, 416.926a, 416.929, 416.945,
416.946, 416.960–416.969a, 416.987,
416.994, and 416.994a.
Introduction
Obesity, when established by
objective medical evidence (signs,
laboratory findings, or both) from an
acceptable medical source (AMS), is an
MDI. We provide guidance in this SSR
on how we establish that a person has
an MDI of obesity, and how we evaluate
obesity in disability claims. People with
obesity have a higher risk for other
impairments, and the effects of obesity
combined with other impairments can
be greater than the effects of each of the
impairments considered separately.
Obesity is not a listed impairment;
however, the functional limitations
caused by the MDI of obesity, either
alone or in combination with another
impairment(s), may medically equal a
listing.2 Obesity in combination with
another impairment(s) may or may not
increase the severity or functional
1 For simplicity, we refer in this SSR only to
initial adult claims for disability benefits under
Titles II and XVI of the Act. The policy
interpretations in this SSR, however, also apply to
claims of children (that is, people who have not
attained age 18) who apply for benefits based on
disability under Title XVI of the Act, continuing
disability reviews of adults and children under
sections 223(f) and 1614(a)(4) of the Act, and
redeterminations of eligibility for benefits we make
in accordance with section 1614(a)(3)(H) of the Act
when a child who is receiving Title XVI payments
based on disability attains age 18.
2 See 20 CFR 404.1526 and 416.926.
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limitations of the other impairment(s).
We evaluate each case based on the
information in the case record.
On September 12, 2002, we published
SSR 02–1p (67 FR 57859) to provide
guidance on the evaluation of obesity in
disability claims. Since then, we
published several final rules that revise
some of the criteria we use to evaluate
disability claims under Titles II and XVI
of the Act. We are issuing this SSR to
reflect the changes to the rules we have
published, and advances in medical
knowledge, since publication of SSR
02–1p.
Policy Interpretation
The following information is in a
question and answer format that
provides guidance on how we establish
that a person has an MDI of obesity and
how we evaluate obesity in disability
claims. Questions 1 and 2 provide basic
background information about obesity
and impairments associated with
obesity. Questions 3 and 4 discuss how
we establish obesity as an MDI and how
we determine if it is a severe MDI.
Questions 5 and 6 specify how we
evaluate obesity under the Listing of
Impairments (listings),3 and how we
consider obesity when assessing a
person’s residual functional capacity
(RFC).
List of Questions
1. How does the medical community
diagnose obesity?
2. Which impairments are associated
with obesity?
3. How do we establish obesity as an
MDI?
4. When is obesity a severe
impairment?
5. How do we evaluate obesity under
the listings?
6. How do we consider obesity in
assessing a person’s RFC?
1. How does the medical community
diagnose obesity?
Obesity is a complex disorder
characterized by an excessive amount of
body fat, and is generally the result of
many factors including environment,
family history and genetics, metabolism,
and behavior. Health care practitioners
diagnose obesity based on a person’s
medical history, physical examinations,
and body mass index (BMI). For adults,
BMI is a person’s weight in kilograms
divided by the square of his or her
height in meters (kg/m2). People with
obesity weigh more than what is
considered the healthy weight for their
height. In the medical community,
obesity is defined as a BMI of 30.0 or
3 See
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20 CFR part 404, subpart P, Appendix 1.
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higher.4 5 No specific weight or BMI
establishes obesity as a severe
impairment within the disability
program. For how we establish obesity
as an MDI, see Question 3. For when we
consider obesity to be a severe
impairment, see Question 4.
Health care practitioners may take a
waist measurement to help diagnose
obesity. If a person’s BMI is within the
normal range, he or she may still have
obesity if his or her waist measurement
is high. People who store more fat
around their waist rather than their hips
may have a greater risk of obesityrelated complications. The risk
increases for a waist size greater than 35
inches for women and greater than 40
inches for men.6
2. Which impairments are associated
with obesity?
Obesity is often associated with
musculoskeletal, respiratory,
cardiovascular, and endocrine
disorders. Obesity also increases the risk
of developing impairments including:
• Type II diabetes mellitus;
• Diseases of the heart and blood
vessels (for example, high blood
pressure, atherosclerosis, heart attacks,
and stroke);
• Respiratory impairments (for
example, sleep apnea, asthma, and
obesity hypoventilation syndrome);
• Osteoarthritis;
• Mental impairments (for example,
depression); and
• Cancers of the esophagus, pancreas,
colon, rectum, kidney, endometrium,
ovaries, gallbladder, breast, or liver.
The fact that obesity increases the risk
for developing other impairments does
not mean that people with obesity
necessarily have any of these
impairments. It means that they are at
greater than average risk for developing
other impairments.
3. How do we establish obesity as an
MDI?
We establish obesity as an MDI by
considering objective medical evidence
4 Jensen, M. D., Ryan, D. H, Donato, K. A.,
Apovian, C. M., Ard, J.D., Comuzzie, A. G., . . .
Yanoski, S. Z. (2014). Guidelines (2013) for
managing overweight and obesity in adults. Obesity,
22(S2), S1–S410. doi:10.1002/oby/20660.
5 For children age 2 and older, weight status is
determined using an age- and gender-specific
percentile for BMI rather than the BMI categories
used for adults. This is because children’s body
composition varies as they age and varies between
boys and girls. Obesity is defined as a BMI-for-age
at or above the 95th percentile. See Barlow, S. E.
(2007). Expert committee recommendations
regarding the prevention, assessment, and treatment
of child and adolescent overweight and obesity:
Summary report. Pediatrics, 120, S164–S192.
doi:10.1542/peds.2007–2329C
6 Jensen, M. D., Ryan, D. H, Donato, K. A.,
Apovian, C. M., Ard, J.D., Comuzzie, A. G., . . .
Yanoski, S. Z. (2014). Guidelines (2013) for
managing overweight and obesity in adults. Obesity,
22(S2), S1–S410. doi:10.1002/oby.20660
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16:41 May 17, 2019
Jkt 247001
(signs, laboratory findings, or both) from
an AMS. We will not use a diagnosis or
a statement of symptoms to establish the
existence of an MDI.7 Signs and
laboratory findings from an AMS that
may establish an MDI of obesity include
measured height and weight, measured
waist size, and BMI measurements over
time.
We calculate BMI based on the
medical evidence in the case record,
even if the person’s medical source(s)
has not indicated that the person has
obesity. We will not calculate BMI
based on a person’s self-reported height
and weight. In addition, we will not
purchase tests to measure body fat.
When deciding whether a person has an
MDI of obesity, we consider the person’s
weight over time. We consider the
person to have an MDI of obesity as long
as his or her weight, measured waist
size, or BMI shows a consistent pattern
of obesity.
Although there is often a correlation
between BMI and excess body fat, this
is not always the case. Someone who
has a BMI of 30 or above may not have
an MDI of obesity if a large percentage
of the person’s weight is from muscle.
It will usually be evident from the
information in the case record whether
the person does not have an MDI of
obesity, despite a BMI of 30 or above.
4. When is obesity a severe
impairment?
When we evaluate the severity of
obesity, we consider all evidence from
all sources. We consider all symptoms,
such as fatigue or pain that could limit
functioning.8 We consider any
functional limitations in the person’s
ability to do basic work activities
resulting from obesity and from any
other physical or mental impairments. If
the person’s obesity, alone or in
combination with another
impairment(s), significantly limits his or
her physical or mental ability to do
basic work activities, we find that the
impairment(s) is severe.9 We find,
however, that the impairment(s) is ‘‘not
severe’’ if it does not significantly limit
[a person’s] physical or mental ability to
do basic work activities.10
No specific weight or BMI establishes
obesity as a ‘‘severe’’ or ‘‘not severe’’
impairment. Similarly, a medical
source’s descriptive terms for levels of
obesity, such as ‘‘severe,’’ ‘‘extreme,’’ or
‘‘morbid,’’ do not establish whether
obesity is a severe impairment for
7 See
20 CFR 404.1521 and 416.921.
20 CFR 404.1529 and 416.929.
9 For children applying for disability under Title
XVI, we find that the impairment(s) is severe when
it causes more than minimal functional limitations.
See 20 CFR 416.924(c).
10 See 20 CFR 404.1522 and 416.922.
8 See
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22925
disability program purposes. We do an
individualized assessment of the effect
of obesity on a person’s functioning
when deciding whether the impairment
is severe.
5. How do we evaluate obesity under
the listings?
Obesity is not a listed impairment;
however, the functional limitations
caused by the MDI of obesity, alone or
in combination with another
impairment(s), may medically equal a
listing.11 For example, obesity may
increase the severity of a coexisting or
related impairment(s) to the extent that
the combination of impairments
medically equals a listing.12
We will not make general
assumptions about the severity or
functional effects of obesity combined
with another impairment(s). Obesity in
combination with another
impairment(s) may or may not increase
the severity or functional limitations of
the other impairment. We evaluate each
case based on the information in the
case record.
6. How do we consider obesity in
assessing a person’s RFC?
We must consider the limiting effects
of obesity when assessing a person’s
RFC.13 RFC is the most an adult can do
despite his or her limitation(s). As with
any other impairment, we will explain
how we reached our conclusion on
whether obesity causes any limitations.
A person may have limitations in any
of the exertional functions, which are
sitting, standing, walking, lifting,
carrying, pushing, and pulling. A person
may have limitations in the
nonexertional functions of climbing,
balancing, stooping, kneeling,
crouching, and crawling. Obesity
increases stress on weight-bearing joints
and may contribute to limitation of the
range of motion of the skeletal spine and
extremities. Obesity may also affect a
person’s ability to manipulate objects, if
there is adipose (fatty) tissue in the
hands and fingers, or the ability to
tolerate extreme heat, humidity, or
hazards.
We assess the RFC to show the effect
obesity has upon the person’s ability to
perform routine movement and
necessary physical activity within the
work environment. People with an MDI
11 See
20 CFR 404.1526 and 416.926.
children applying for disability under Title
XVI, we may evaluate the functional consequences
of obesity (either alone or in combination with
other impairments) to decide if the child’s
impairment(s) functionally equals the listings. For
example, the functional limitations imposed by
obesity, by itself or in combination with another
impairment(s), may establish extreme limitation of
one domain of functioning or marked limitation of
two domains. See 20 CFR 416.926a.
13 See 20 CFR 404.1545 and 416.945.
12 For
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Federal Register / Vol. 84, No. 97 / Monday, May 20, 2019 / Notices
of obesity may have limitations in the
ability to sustain a function over time.
In cases involving obesity, fatigue may
affect the person’s physical and mental
ability to sustain work activity. This
may be particularly true in cases
involving obesity and sleep apnea.
The combined effects of obesity with
another impairment(s) may be greater
than the effects of each of the
impairments considered separately. For
example, someone who has obesity and
arthritis affecting a weight-bearing joint
may have more pain and functional
limitations than the person would have
due to the arthritis alone. We consider
all work-related physical and mental
limitations, whether due to a person’s
obesity, other impairment(s), or
combination of impairments.
This SSR is applicable on May 20,
2019.14
Cross References: SSR 82–52: Titles II
and XVI: Duration of the Impairment;
SSR 85–28: Titles II and XVI: Medical
Impairments That Are Not Severe; SSR
86–8: Titles II and XVI: The Sequential
Evaluation Process; SSR 96–8p: Titles II
and XVI: Assessing Residual Functional
Capacity in Initial Claims; SSR 16–3p:
Titles II and XVI: Evaluation of
Symptoms in Disability Claims; SSR 17–
2p: Titles II and XVI: Evidence Needed
by Adjudicators at the Hearings and
Appeals Council Levels of the
Administrative Review Process to Make
Findings about Medical Equivalence;
and Program Operations Manual System
(POMS) DI 22505.001, DI 22505.003, DI
24501.020, DI 24501.021, DI 24503.005,
DI 24505.001, DI 24505.005, DI
24508.010, DI 24510.005, DI 24515.062,
and DI 24515.063.
[FR Doc. 2019–10432 Filed 5–17–19; 8:45 am]
BILLING CODE 4191–02–P
DEPARTMENT OF STATE
[Public Notice: 10769]
Notice of Determinations; Culturally
Significant Objects Imported for
Exhibition—Determinations: ‘‘The
Colmar Treasure: A Medieval Jewish
Legacy’’ Exhibition
Notice is hereby given of the
following determinations: I hereby
determine that certain objects to be
included in the exhibition ‘‘The Colmar
Treasure: A Medieval Jewish Legacy,’’
imported from abroad for temporary
exhibition within the United States, are
of cultural significance. The objects are
imported pursuant to loan agreements
with the foreign owners or custodians.
I also determine that the exhibition or
display of the exhibit objects at The Met
Cloisters, New York, New York, from on
or about July 22, 2019, until on or about
January 12, 2020, and at possible
additional exhibitions or venues yet to
be determined, is in the national
interest. I have ordered that Public
Notice of these determinations be
published in the Federal Register.
FOR FURTHER INFORMATION CONTACT:
Elliot Chiu, Attorney-Adviser, Office of
the Legal Adviser, U.S. Department of
State (telephone: 202–632–6471; email:
section2459@state.gov). The mailing
address is U.S. Department of State, L/
PD, SA–5, Suite 5H03, Washington, DC
20522–0505.
SUPPLEMENTARY INFORMATION: The
foregoing determinations were made
pursuant to the authority vested in me
by the Act of October 19, 1965 (79 Stat.
985; 22 U.S.C. 2459), Executive Order
12047 of March 27, 1978, the Foreign
Affairs Reform and Restructuring Act of
1998 (112 Stat. 2681, et seq.; 22 U.S.C.
6501 note, et seq.), Delegation of
Authority No. 234 of October 1, 1999,
and Delegation of Authority No. 236–3
of August 28, 2000.
SUMMARY:
Marie Therese Porter Royce,
Assistant Secretary, Educational and Cultural
Affairs, Department of State.
[FR Doc. 2019–10404 Filed 5–17–19; 8:45 am]
BILLING CODE 4710–05–P
khammond on DSKBBV9HB2PROD with NOTICES
14 We
will use this SSR beginning on its
applicable date. We will apply this SSR to new
applications filed on or after the applicable date of
the SSR and to claims that are pending on and after
the applicable date. This means that we will use
this SSR on and after its applicable date in any case
in which we make a determination or decision. We
expect that Federal courts will review our final
decisions using the rules that were in effect at the
time we issued the decisions. If a court reverses our
final decision and remands a case for further
administrative proceedings after the applicable date
of this SSR, we will apply this SSR to the entire
period at issue in the decision we make after the
court’s remand.
VerDate Sep<11>2014
16:41 May 17, 2019
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DEPARTMENT OF STATE
[Public Notice 10770]
Overseas Security Advisory Council
(OSAC) Meeting Notice; Closed
Meeting
The Department of State announces a
meeting of the U.S. State Department
Overseas Security Advisory Council on
June 5, 2019. Pursuant to Section 10(d)
of the Federal Advisory Committee Act
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(5 U.S.C. Appendix), 5 U.S.C.
552b(c)(4), and 5 U.S.C. 552b(c)(7)(E), it
has been determined that the meeting
will be closed to the public. The
meeting will focus on an examination of
corporate security policies and
procedures and will involve extensive
discussion of trade secrets and
proprietary commercial information that
is privileged and confidential, and will
discuss law enforcement investigative
techniques and procedures. The agenda
will include updated committee reports,
a global threat overview, and other
matters relating to private sector
security policies and protective
programs and the protection of U.S.
business information overseas.
For more information, contact:
Marsha Thurman, Overseas Security
Advisory Council, U.S. Department of
State, Washington, DC 20522–2008,
phone: 571–345–2214.
Thomas G. Scanlon,
Executive Director, Overseas Security
Advisory Council, U.S. Department of State.
[FR Doc. 2019–10405 Filed 5–17–19; 8:45 am]
BILLING CODE 4710–24–P
DEPARTMENT OF STATE
[Public Notice: 10771]
Notice of Determinations; Additional
Culturally Significant Objects Imported
for Exhibition—Determinations: ‘‘The
Allure of Matter: Material Art of China’’
Exhibition
On April 26, 2019, notice was
published on page 17908 of the Federal
Register (volume 84, number 81) of
determinations pertaining to certain
objects to be included in an exhibition
entitled ‘‘The Allure of Matter: Material
Art of China.’’ Notice is hereby given of
the following determinations: I hereby
determine that certain additional objects
to be included in the exhibition ‘‘The
Allure of Matter: Material Art of China,’’
imported from abroad for temporary
exhibition within the United States, are
of cultural significance. The additional
objects are imported pursuant to loan
agreements with the foreign owners or
custodians. I also determine that the
exhibition or display of the additional
exhibit objects at the Los Angeles
County Museum of Art, Los Angeles,
California, from on or about June 6,
2019, until on or about January 5, 2020,
at the David and Alfred Smart Museum
of Art and the Wrightwood 659 Gallery,
both in Chicago, Illinois, from on or
about February 4, 2020, until on or
about May 3, 2020, at the Seattle Art
Museum, Seattle, Washington, from on
or about June 25, 2020, until on or about
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]]>Agencies
[Federal Register Volume 84, Number 97 (Monday, May 20, 2019)]
[Notices]
[Pages 22924-22926]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-10432]
[[Page 22924]]
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SOCIAL SECURITY ADMINISTRATION
[Docket No. SSA-2018-0022]
Social Security Ruling, SSR 19-2p; Titles II and XVI: Evaluating
Cases Involving Obesity
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling (SSR).
-----------------------------------------------------------------------
SUMMARY: We are providing notice of SSR 19-2p. This SSR provides
guidance on how we establish that a person has a medically determinable
impairment of obesity and how we evaluate obesity in disability claims
under Titles II and XVI of the Social Security Act.
DATES: We will apply this notice on May 20, 2019.
FOR FURTHER INFORMATION CONTACT: Cheryl A. Williams, Office of
Disability Policy, Social Security Administration, 6401 Security
Boulevard, Baltimore, Maryland 21235-6401, (410) 965-1020. 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 under 20 CFR
402.35(b)(1).
Through SSRs, we make available to the public 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 of our components. 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 until we publish a new SSR that
replaces or modifies it.
(Catalog of Federal Domestic Assistance, Program 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: Evaluating Cases Involving Obesity
This Social Security Ruling (SSR) rescinds and replaces SSR 02-1p;
Titles II and XVI: Evaluation of Obesity.
Purpose: This SSR provides guidance on how we establish that a
person has a medically determinable impairment (MDI) of obesity and how
we evaluate obesity in disability claims under Titles II and XVI of the
Social Security Act (Act).\1\
---------------------------------------------------------------------------
\1\ For simplicity, we refer in this SSR only to initial adult
claims for disability benefits under Titles II and XVI of the Act.
The policy interpretations in this SSR, however, also apply to
claims of children (that is, people who have not attained age 18)
who apply for benefits based on disability under Title XVI of the
Act, continuing disability reviews of adults and children under
sections 223(f) and 1614(a)(4) of the Act, and redeterminations of
eligibility for benefits we make in accordance with section
1614(a)(3)(H) of the Act when a child who is receiving Title XVI
payments based on disability attains age 18.
---------------------------------------------------------------------------
Citations (Authority): Sections 216(i), 223(d), 223(f), 1614(a),
and 1614(c) of the Act, as amended; Regulations No. 4, subpart P,
sections 404.1502, 404.1509, 404.1512, 404.1513, 404.1520, 404.1521-
404.1523, 404.1525, 404.1526, 404.1529, 404.1545, 404.1546, 404.1560-
404.1569a, 404.1594 and appendices 1 and 2; Regulations No. 16, subpart
I, sections 416.902, 416.909, 416.912, 416.913, 416.920, 416.921-
416.923, 416.924, 416.924a, 416.925, 416.926, 416.926a, 416.929,
416.945, 416.946, 416.960-416.969a, 416.987, 416.994, and 416.994a.
Introduction
Obesity, when established by objective medical evidence (signs,
laboratory findings, or both) from an acceptable medical source (AMS),
is an MDI. We provide guidance in this SSR on how we establish that a
person has an MDI of obesity, and how we evaluate obesity in disability
claims. People with obesity have a higher risk for other impairments,
and the effects of obesity combined with other impairments can be
greater than the effects of each of the impairments considered
separately. Obesity is not a listed impairment; however, the functional
limitations caused by the MDI of obesity, either alone or in
combination with another impairment(s), may medically equal a
listing.\2\ Obesity in combination with another impairment(s) may or
may not increase the severity or functional limitations of the other
impairment(s). We evaluate each case based on the information in the
case record.
---------------------------------------------------------------------------
\2\ See 20 CFR 404.1526 and 416.926.
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On September 12, 2002, we published SSR 02-1p (67 FR 57859) to
provide guidance on the evaluation of obesity in disability claims.
Since then, we published several final rules that revise some of the
criteria we use to evaluate disability claims under Titles II and XVI
of the Act. We are issuing this SSR to reflect the changes to the rules
we have published, and advances in medical knowledge, since publication
of SSR 02-1p.
Policy Interpretation
The following information is in a question and answer format that
provides guidance on how we establish that a person has an MDI of
obesity and how we evaluate obesity in disability claims. Questions 1
and 2 provide basic background information about obesity and
impairments associated with obesity. Questions 3 and 4 discuss how we
establish obesity as an MDI and how we determine if it is a severe MDI.
Questions 5 and 6 specify how we evaluate obesity under the Listing of
Impairments (listings),\3\ and how we consider obesity when assessing a
person's residual functional capacity (RFC).
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\3\ See 20 CFR part 404, subpart P, Appendix 1.
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List of Questions
1. How does the medical community diagnose obesity?
2. Which impairments are associated with obesity?
3. How do we establish obesity as an MDI?
4. When is obesity a severe impairment?
5. How do we evaluate obesity under the listings?
6. How do we consider obesity in assessing a person's RFC?
1. How does the medical community diagnose obesity?
Obesity is a complex disorder characterized by an excessive amount
of body fat, and is generally the result of many factors including
environment, family history and genetics, metabolism, and behavior.
Health care practitioners diagnose obesity based on a person's medical
history, physical examinations, and body mass index (BMI). For adults,
BMI is a person's weight in kilograms divided by the square of his or
her height in meters (kg/m\2\). People with obesity weigh more than
what is considered the healthy weight for their height. In the medical
community, obesity is defined as a BMI of 30.0 or
[[Page 22925]]
higher.4 5 No specific weight or BMI establishes obesity as
a severe impairment within the disability program. For how we establish
obesity as an MDI, see Question 3. For when we consider obesity to be a
severe impairment, see Question 4.
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\4\ Jensen, M. D., Ryan, D. H, Donato, K. A., Apovian, C. M.,
Ard, J.D., Comuzzie, A. G., . . . Yanoski, S. Z. (2014). Guidelines
(2013) for managing overweight and obesity in adults. Obesity,
22(S2), S1-S410. doi:10.1002/oby/20660.
\5\ For children age 2 and older, weight status is determined
using an age- and gender-specific percentile for BMI rather than the
BMI categories used for adults. This is because children's body
composition varies as they age and varies between boys and girls.
Obesity is defined as a BMI-for-age at or above the 95th percentile.
See Barlow, S. E. (2007). Expert committee recommendations regarding
the prevention, assessment, and treatment of child and adolescent
overweight and obesity: Summary report. Pediatrics, 120, S164-S192.
doi:10.1542/peds.2007-2329C
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Health care practitioners may take a waist measurement to help
diagnose obesity. If a person's BMI is within the normal range, he or
she may still have obesity if his or her waist measurement is high.
People who store more fat around their waist rather than their hips may
have a greater risk of obesity-related complications. The risk
increases for a waist size greater than 35 inches for women and greater
than 40 inches for men.\6\
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\6\ Jensen, M. D., Ryan, D. H, Donato, K. A., Apovian, C. M.,
Ard, J.D., Comuzzie, A. G., . . . Yanoski, S. Z. (2014). Guidelines
(2013) for managing overweight and obesity in adults. Obesity,
22(S2), S1-S410. doi:10.1002/oby.20660
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2. Which impairments are associated with obesity?
Obesity is often associated with musculoskeletal, respiratory,
cardiovascular, and endocrine disorders. Obesity also increases the
risk of developing impairments including:
Type II diabetes mellitus;
Diseases of the heart and blood vessels (for example, high
blood pressure, atherosclerosis, heart attacks, and stroke);
Respiratory impairments (for example, sleep apnea, asthma,
and obesity hypoventilation syndrome);
Osteoarthritis;
Mental impairments (for example, depression); and
Cancers of the esophagus, pancreas, colon, rectum, kidney,
endometrium, ovaries, gallbladder, breast, or liver.
The fact that obesity increases the risk for developing other
impairments does not mean that people with obesity necessarily have any
of these impairments. It means that they are at greater than average
risk for developing other impairments.
3. How do we establish obesity as an MDI?
We establish obesity as an MDI by considering objective medical
evidence (signs, laboratory findings, or both) from an AMS. We will not
use a diagnosis or a statement of symptoms to establish the existence
of an MDI.\7\ Signs and laboratory findings from an AMS that may
establish an MDI of obesity include measured height and weight,
measured waist size, and BMI measurements over time.
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\7\ See 20 CFR 404.1521 and 416.921.
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We calculate BMI based on the medical evidence in the case record,
even if the person's medical source(s) has not indicated that the
person has obesity. We will not calculate BMI based on a person's self-
reported height and weight. In addition, we will not purchase tests to
measure body fat. When deciding whether a person has an MDI of obesity,
we consider the person's weight over time. We consider the person to
have an MDI of obesity as long as his or her weight, measured waist
size, or BMI shows a consistent pattern of obesity.
Although there is often a correlation between BMI and excess body
fat, this is not always the case. Someone who has a BMI of 30 or above
may not have an MDI of obesity if a large percentage of the person's
weight is from muscle. It will usually be evident from the information
in the case record whether the person does not have an MDI of obesity,
despite a BMI of 30 or above.
4. When is obesity a severe impairment?
When we evaluate the severity of obesity, we consider all evidence
from all sources. We consider all symptoms, such as fatigue or pain
that could limit functioning.\8\ We consider any functional limitations
in the person's ability to do basic work activities resulting from
obesity and from any other physical or mental impairments. If the
person's obesity, alone or in combination with another impairment(s),
significantly limits his or her physical or mental ability to do basic
work activities, we find that the impairment(s) is severe.\9\ We find,
however, that the impairment(s) is ``not severe'' if it does not
significantly limit [a person's] physical or mental ability to do basic
work activities.\10\
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\8\ See 20 CFR 404.1529 and 416.929.
\9\ For children applying for disability under Title XVI, we
find that the impairment(s) is severe when it causes more than
minimal functional limitations. See 20 CFR 416.924(c).
\10\ See 20 CFR 404.1522 and 416.922.
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No specific weight or BMI establishes obesity as a ``severe'' or
``not severe'' impairment. Similarly, a medical source's descriptive
terms for levels of obesity, such as ``severe,'' ``extreme,'' or
``morbid,'' do not establish whether obesity is a severe impairment for
disability program purposes. We do an individualized assessment of the
effect of obesity on a person's functioning when deciding whether the
impairment is severe.
5. How do we evaluate obesity under the listings?
Obesity is not a listed impairment; however, the functional
limitations caused by the MDI of obesity, alone or in combination with
another impairment(s), may medically equal a listing.\11\ For example,
obesity may increase the severity of a coexisting or related
impairment(s) to the extent that the combination of impairments
medically equals a listing.\12\
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\11\ See 20 CFR 404.1526 and 416.926.
\12\ For children applying for disability under Title XVI, we
may evaluate the functional consequences of obesity (either alone or
in combination with other impairments) to decide if the child's
impairment(s) functionally equals the listings. For example, the
functional limitations imposed by obesity, by itself or in
combination with another impairment(s), may establish extreme
limitation of one domain of functioning or marked limitation of two
domains. See 20 CFR 416.926a.
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We will not make general assumptions about the severity or
functional effects of obesity combined with another impairment(s).
Obesity in combination with another impairment(s) may or may not
increase the severity or functional limitations of the other
impairment. We evaluate each case based on the information in the case
record.
6. How do we consider obesity in assessing a person's RFC?
We must consider the limiting effects of obesity when assessing a
person's RFC.\13\ RFC is the most an adult can do despite his or her
limitation(s). As with any other impairment, we will explain how we
reached our conclusion on whether obesity causes any limitations.
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\13\ See 20 CFR 404.1545 and 416.945.
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A person may have limitations in any of the exertional functions,
which are sitting, standing, walking, lifting, carrying, pushing, and
pulling. A person may have limitations in the nonexertional functions
of climbing, balancing, stooping, kneeling, crouching, and crawling.
Obesity increases stress on weight-bearing joints and may contribute to
limitation of the range of motion of the skeletal spine and
extremities. Obesity may also affect a person's ability to manipulate
objects, if there is adipose (fatty) tissue in the hands and fingers,
or the ability to tolerate extreme heat, humidity, or hazards.
We assess the RFC to show the effect obesity has upon the person's
ability to perform routine movement and necessary physical activity
within the work environment. People with an MDI
[[Page 22926]]
of obesity may have limitations in the ability to sustain a function
over time. In cases involving obesity, fatigue may affect the person's
physical and mental ability to sustain work activity. This may be
particularly true in cases involving obesity and sleep apnea.
The combined effects of obesity with another impairment(s) may be
greater than the effects of each of the impairments considered
separately. For example, someone who has obesity and arthritis
affecting a weight-bearing joint may have more pain and functional
limitations than the person would have due to the arthritis alone. We
consider all work-related physical and mental limitations, whether due
to a person's obesity, other impairment(s), or combination of
impairments.
This SSR is applicable on May 20, 2019.\14\
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\14\ We will use this SSR beginning on its applicable date. We
will apply this SSR to new applications filed on or after the
applicable date of the SSR and to claims that are pending on and
after the applicable date. This means that we will use this SSR on
and after its applicable date in any case in which we make a
determination or decision. We expect that Federal courts will review
our final decisions using the rules that were in effect at the time
we issued the decisions. If a court reverses our final decision and
remands a case for further administrative proceedings after the
applicable date of this SSR, we will apply this SSR to the entire
period at issue in the decision we make after the court's remand.
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Cross References: SSR 82-52: Titles II and XVI: Duration of the
Impairment; SSR 85-28: Titles II and XVI: Medical Impairments That Are
Not Severe; SSR 86-8: Titles II and XVI: The Sequential Evaluation
Process; SSR 96-8p: Titles II and XVI: Assessing Residual Functional
Capacity in Initial Claims; SSR 16-3p: Titles II and XVI: Evaluation of
Symptoms in Disability Claims; SSR 17-2p: Titles II and XVI: Evidence
Needed by Adjudicators at the Hearings and Appeals Council Levels of
the Administrative Review Process to Make Findings about Medical
Equivalence; and Program Operations Manual System (POMS) DI 22505.001,
DI 22505.003, DI 24501.020, DI 24501.021, DI 24503.005, DI 24505.001,
DI 24505.005, DI 24508.010, DI 24510.005, DI 24515.062, and DI
24515.063.
[FR Doc. 2019-10432 Filed 5-17-19; 8:45 am]
BILLING CODE 4191-02-P
