Federal Register / Vol. 80, No. 52 / Wednesday, March 18, 2015 / Notices 14215 

148See Proposing Release, supra note 3. 

149See supra note 6. 150 17 CFR 200.30–3(a)(12). 

1We will use this Social Security Ruling (SSR) 

beginning on its effective date. We will apply this 

SSR to new applications filed on or after the 

effective date of the SSR and to claims that are 

pending on and after the effective date. This means 

that we will use these rules on and after their 

effective 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 rules and 

remands a case for further administrative 

proceedings after the effective date of these final 

rules, we will apply these final rules to the entire 

period at issue in the decision we make after the 

court’s remand. 

2For simplicity, we refer in this SSR only to 

initial adult claims for disability benefits under 

titles II and XVI of the Act and to the steps of the 

Continued 

the Proposing Release. FINRA’s 

response to comments and proposed 

revisions as set forth in this Amendment 

No. 1 does not change FINRA’s 

statement in the Proposing Release. 

C. Self-Regulatory Organization’s 

Statement on Comments on the 

Proposed Rule Change Received From 

Members, Participants, or Others 

Written comments on the proposed 

rule change were solicited by the 

Commission in response to the 

publication of SR–FINRA–2014–048.148

The Commission received five comment 

letters, which are summarized above. 

IV. Date of Effectiveness of the 

Proposed Rule Change and Timing for 

Commission Action 

Within 180 days after the date of 

publication of the initial notice in the 

Federal Register (i.e., November 24, 

2014) or within such longer period up 

to an additional 60 days (i) as the 

Commission may designate if it finds 

such longer period to be appropriate 

and publishes its reasons for so finding 

or (ii) as to which the self-regulatory 

organization consents, the Commission 

will issue an order approving or 

disapproving such proposed rule 

change, as amended. 

V. Solicitation of Comments 

Interested persons are invited to 

submit written data, views and 

arguments concerning the foregoing, 

including whether the proposed rule 

change is consistent with the Act. 

Comments may be submitted by any of 

the following methods: 149

Electronic Comments 

• Use the Commission’s Internet 

comment form (http://www.sec.gov/

rules/sro.shtml); or 

• Send an email to rule-comments@

sec.gov. Please include File Number SR– 

FINRA–2014–048 on the subject line. 

Paper Comments 

• Send paper comments in triplicate 

to Brent J. Fields, Secretary, Securities 

and Exchange Commission, 100 F Street 

NE., Washington, DC 20549–1090. 

All submissions should refer to File 

Number SR–FINRA–2014–048. 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 (http://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 

a.m. and 3 p.m. Copies of such filing 

also will be available for inspection and 

copying at the principal office of 

FINRA. 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–FINRA–2014–048 and 

should be submitted on or before April 

8, 2015. 

For the Commission, by the Division of 

Trading and Markets, pursuant to delegated 

authority.150

Brent J. Fields, 

Secretary. 

[FR Doc. 2015–06094 Filed 3–17–15; 8:45 am] 

BILLING CODE 8011–01–P 

SOCIAL SECURITY ADMINISTRATION 

[Docket No. SSA–2014–0053] 

Social Security Ruling, SSR 15–1p; 

Titles II and XVI: Evaluating Cases 

Involving Interstitial Cystitis (IC) 

AGENCY: Social Security Administration. 

ACTION: Notice of Social Security Ruling 

(SSR). 

SUMMARY: We are providing notice of 

SSR 15–1p. This SSR provides guidance 

on how we develop evidence to 

establish that a person has a medically 

determinable impairment of interstitial 

cystitis (IC), and how we evaluate IC in 

disability claims and continuing 

disability reviews under titles II and 

XVI of the Social Security Act. 

DATES: Effective Date: March 18, 2015. 

FOR FURTHER INFORMATION CONTACT: 

Cheryl Williams, Office of Medical 

Policy, Social Security Administration, 

6401 Security Boulevard, Baltimore, 

Maryland 21235–6401, (410) 965–1020. 

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. 

(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 3, 2015. 

Carolyn W. Colvin, 

Acting Commissioner of Social Security. 

Policy Interpretation Ruling 

Titles II and XVI: Evaluating Cases 

Involving Interstitial Cystitis (IC) 

This Social Security Ruling (SSR) 

rescinds and replaces SSR 02–2p: 

‘‘Titles II and XVI: Evaluation of 

Interstitial Cystitis.’’ 1

Purpose: This SSR clarifies our policy 

on how we develop evidence to 

establish that a person has a medically 

determinable impairment (MDI) of IC 

and how we evaluate this impairment in 

disability claims and continuing 

disability reviews under titles II and 

XVI of the Social Security Act (Act).2

mstockstill on DSK4VPTVN1PROD with NOTICES

14216 Federal Register / Vol. 80, No. 52 / Wednesday, March 18, 2015 / Notices 

sequential evaluation process we use to determine 

disability in those claims. 20 CFR 404.1520 and 

416.920. The policy interpretations in this SSR 

apply to all cases in which we must make 

determinations about disability, including 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, disability redeterminations for 

children who became eligible for Supplemental 

Security Income under title XVI as a child and who 

were eligible for such benefits for the month before 

the month in which they attained age 18, and to 

continuing disability reviews of adults and children 

under titles II and XVI of the Act. 20 CFR 404.1594, 

416.924, 416.987, 416.994, and 416.994a. 

3Hanno, P.M., et al., Diagnosis and treatment of 

interstitial cystitis/bladder pain syndrome, 

American Urological Association, (2014) (available 

at: http://www.auanet.org/common/pdf/education/

clinical-guidance/IC-Bladder-Pain-SyndromeRevised.pdf). 

4Hanno, P. and Dmochowski, R., Status of 

international consensus on interstitial cystitis/

bladder pain syndrome/painful bladder syndrome: 

2008 snapshot, Neurology and Urodynamics, 

Apr;28(4), 274–286 (2009). 

5See NIDDK National Kidney and Urologic 

Diseases Information Clearinghouse, ‘‘Interstitial 

Cystitis/Painful Bladder Syndrome’’ (2013) 

available at: http://kidney.niddk.nih.gov/

KUDiseases/pubs/interstitialcystitis/index.aspx. 

6 Gillenwater, J.Y., et al., Summary of the 

National Institute of Arthritis, Diabetes, Digestive 

and Kidney Diseases Workshop on Interstitial 

Cystitis, National Institutes of Health, Bethesda, 

Maryland, August 28–29, 1987, The Journal of 

Urology, Jul;140(1), 203–206 (1988). 

7We adapted the AUA and NIDDK descriptions 

of IC, which are mainly symptom-based, because 

the Act and our regulations require a claimant to 

establish by objective medical evidence (that is, 

medical signs and laboratory findings) that he or 

she has a medically determinable impairment. See 

223(d)(5)(A) and 1614(a)(3)(D) of the Act, 20 CFR 

404.1508 and 416.908, and SSR 96–4p: Titles II and 

XVI: Symptoms, Medically Determinable Physical 

and Mental Impairments, and Exertional and 

Nonexertional Limitations, 61 FR 34388 (1996) (also 

available at: http://www.ssa.gov/OP_Home/rulings/

di/01/SSR96-04-di-01.html). 

8See 20 CFR 404.1505 and 416.905. 

9See sections 223(d)(3) and 1614(a)(3)(D) of the 

Act, and 20 CFR 404.1508 and 416.908. 

10See sections 223(d)(5)(A) and 1614(a)(3)(D) of 

the Act; 20 CFR 404.1508 and 416.908; and SSR 96– 

4p. 

11See NIDDK National Kidney and Urologic 

Diseases Information Clearinghouse (available at: 

http://kidney.niddk.nih.gov/KUDiseases/pubs/

interstitialcystitis/index.aspx). 

Citations: Sections 216(i), 223(d), 

223(f), 1614(a)(3) and 1614(a)(4) of the 

Social Security Act, as amended; 

Regulations No. 4, subpart P, sections 

404.1502, 404.1505, 04.1508–404.1513, 

404.1519a, 404.1520, 404.1520a, 

404.1520b, 404.1521, 404.1523, 

404.1526, 404.1527–404.1529, 404.1545, 

404.1560–404.1569a, 404.1593, 

404.1594, appendices 1 and 2; and 

Regulations No. 16, subpart I, sections 

416.902, 416.905, 416.906, 416.908– 

416.913, 416.919a, 416.920, 416.920a, 

416.920b, 416.921, 416.923, 416.924, 

416.924a, 416.926, 416.926a, 416.925, 

416.927–416.929, 416.945, 416.960– 

416–969a, 416.987, 416.993, 416.994, 

and 416.994a. 

Introduction 

IC is a complex genitourinary disorder 

involving recurring pain or discomfort 

in the bladder and pelvic region. The 

American Urological Association 

(AUA), National Institute of Diabetes 

and Digestive and Kidney Diseases 

(NIDDK), and other medical experts may 

use the terms ‘‘interstitial cystitis/

bladder pain syndrome (IC/BPS)’’ and 

‘‘interstitial cystitis/painful bladder 

syndrome (IC/PBS)’’ to describe this 

disorder because they consider the term 

‘‘interstitial cystitis’’ to be synonymous 

with the terms ‘‘bladder pain 

syndrome’’ and ‘‘painful bladder 

syndrome.’’ When we refer to IC in this 

SSR, we include IC/BPS and IC/PBS. 

The AUA has developed guidelines 

providing a clinical framework for 

diagnosing and treating IC/BPS.3 These 

guidelines use a definition of IC 

accepted by the Society for 

Urodynamics and Female Urology: ‘‘An 

unpleasant sensation (pain, pressure, 

discomfort) perceived to be related to 

the urinary bladder, associated with 

lower urinary tract symptoms of more 

than six weeks duration, in the absence 

of infection or other identifiable 

causes.’’ 4 NIDDK’s National Kidney and 

Urologic Diseases Information 

Clearinghouse explains that the term IC/ 

PBS (and IC/BPS) includes all cases of 

urinary pain not attributed to other 

causes, such as infection or urinary 

stones.5 NIDDK further explains that the 

term ‘‘interstitial cystitis’’ is used alone 

(without PBS or BPS) to describe cases 

of urinary pain that meet all of the IC 

criteria NIDDK established in 1987 for 

research purposes.6 We took into 

consideration the AUA and NIDDK 

descriptions of IC when we formulated 

the criteria in this SSR. For example, we 

adapted the AUA and NIDDK 

descriptions to help develop criteria for 

establishing an MDI of IC.7

Except for statutory blindness, we 

find a person to be ‘‘disabled’’ if he or 

she is unable to do any substantial 

gainful activity by reason of a medically 

determinable physical or mental 

impairment(s) or combination of 

impairments that can be expected to 

result in death or has lasted or can be 

expected to last for a continuous period 

of not less than 12 months.8 We require 

an MDI to result from anatomical, 

physiological, or psychological 

abnormalities, as shown by medically 

acceptable clinical and laboratory 

diagnostic techniques.9 The Act and our 

regulations further require that medical 

evidence establishing an MDI consist of 

signs, symptoms, and laboratory 

findings. Thus, we cannot determine 

that a person who has IC is disabled on 

the basis of his or her statement of 

symptoms alone.10 In this SSR, we 

explain that IC, when accompanied by 

appropriate symptoms and medical 

signs or laboratory findings, is an MDI 

that can be the basis for a finding of 

‘‘disability.’’ We also explain how we 

evaluate IC in disability claims. 

Policy Interpretation 

IC constitutes an MDI when 

producing appropriate symptoms and 

medical signs or laboratory findings, 

and may result in a disabling 

impairment. There are some signs and 

findings that could indicate IC, but there 

are no specific signs or findings that are 

universally accepted. However, for our 

program purposes, we are choosing to 

rely upon certain signs and findings to 

establish the existence of an MDI of IC. 

Once we establish that a person has an 

MDI of IC by taking into consideration 

these signs or findings, we use the 

sequential evaluation process to 

determine whether the person is 

disabled. This policy interpretation 

clarifies how our adjudicators should 

apply our regulations in establishing an 

MDI of IC and determining disability 

under titles II and XVI of the Act. 

I. What is IC? 

A. IC is a complex genitourinary 

disorder resulting in recurring pain or 

discomfort in the bladder and pelvic 

region. The AUA and other medical 

experts characterize IC, in part, as an 

unpleasant sensation (pain, pressure, 

discomfort) perceived to be related to 

the urinary bladder, associated with 

lower urinary tract symptoms of more 

than six weeks duration, in the absence 

of infection or other identifiable causes. 

IC is most common in women and 

sometimes occurs before age 18.11 It is 

not unusual for people to have 

prodromal (early predictive) symptoms 

years or decades before they get IC. 

Prodromal symptoms may include 

periodic episodes of urinary frequency, 

bladder pain, or pelvic pain. 

B. In accordance with the AUA 

guidelines, a physician should make a 

diagnosis of IC only after reviewing the 

person’s medical history and 

conducting a physical examination. The 

physician should also conduct 

laboratory tests to rule out certain 

medical conditions that may result in 

the same or similar symptoms. For 

example, the AUA guidelines 

recommend a basic laboratory 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 80, No. 52 / Wednesday, March 18, 2015 / Notices 14217 

12 Descriptions of these tests are available at 

http://kidney.niddk.nih.gov/kudiseases/pubs/

interstitialcystitis/#diagnosis. Evidence that a 

physician used any of these tests or other laboratory 

tests to make a diagnosis of IC (that is, to rule out 

other diseases that could explain the person’s 

symptoms) helps establish the existence of an MDI 

of IC. 

13See 20 CFR 404.1513(a) and 416.913(a). 

14We may consider an acceptable medical source 

who has treated or evaluated the person only a few 

times or only after long intervals (for example, 

twice a year) to be a treating source. See 20 CFR 

404.1502 and 416.902. 

15We use the term ‘‘not inconsistent’’ to indicate 

that a diagnosis of IC need not be supported directly 

by all the other evidence (that is, it does not have 

to be consistent with all the other evidence) as long 

as there is no other substantial evidence in the case 

record that contradicts or conflicts with the 

diagnosis. Whether a diagnosis of IC is ‘‘not 

inconsistent’’ with the other substantial evidence is 

a judgment that adjudicators must make in each 

case. In situations in which the diagnosis of IC is 

inconsistent with the other substantial evidence in 

the person’s case record, the adjudicator may 

determine that the diagnosis is not entitled to 

‘‘controlling weight’’ in establishing whether the 

person has an MDI. However, the adjudicator 

should not reject the diagnosis, but instead must 

weigh it using all of the factors provided in 20 CFR 

404.1527 and 416.927. See SSR 96–2p, Titles II and 

XVI: Giving Controlling Weight to Treating Source 

Medical Opinions, 61 FR 34492 2006 (also available 

at: http://www.socialsecurity.gov/OP_Home/

rulings/di/01/SSR96-02-di-01.html). 

16See NIDDK National Kidney and Urologic 

Diseases Information Clearinghouse (available at: 

http://kidney.niddk.nih.gov/KUDiseases/pubs/

interstitialcystitis/index.aspx.) As used by the 

NIDDK, the word ‘‘severe’’ is not meant in the same 

sense that we use the word to describe a severe 

impairment at the second step of our sequential 

evaluation process. 

17We will not purchase this procedure to 

establish an MDI of IC because it is an invasive 

procedure. 

18Hunner’s ulcers are rare and may be present in 

only 5–10 percent of individuals with IC. 

19Although validated by some studies, the 

potassium sensitivity test is not yet recommended 

for routine clinical use and can be painful for the 

patient. We will not purchase this procedure to 

establish an MDI of IC because it is an invasive 

procedure. 

20Physicians do not routinely measure APF. 

examination that includes urinalysis 

and urine culture. NIDDK notes that 

diagnostic tests physicians may also use 

to rule out other conditions include 

cystoscopy, biopsy of the bladder wall 

and urethra, distention of the bladder 

under anesthesia, and, in men, culture 

of prostate secretions.12

C. IC may co-occur with fibromyalgia, 

chronic fatigue syndrome, irritable 

bowel syndrome, inflammatory bowel 

disease, vulvodynia, chronic headaches, 

Sjo ̈gren’s syndrome, endometriosis, or 

systemic lupus erythematosus. 

D. Treatments for IC are mostly 

directed at symptom control. They 

include, but are not limited to: Changes 

in diet; physical therapy and pelvic 

floor strengthening exercises; stress 

management; bladder distention; 

bladder instillation; oral drugs, such as 

prescription drugs indicated for IC (for 

example, Elmiron and dimethyl 

sulfoxide), antidepressants, 

antihistamines, antacids, anticoagulants, 

and narcotic analgesics; transcutaneous 

electrical nerve stimulation; and 

surgery, such as substitution cystoplasty 

or urinary diversion with or without 

cystectomy. Treatment is not effective 

for everyone because response varies 

among patients. 

II. How does a person establish an MDI 

of IC? 

A. General 

1. A person can establish that he or 

she has an MDI of IC by providing 

appropriate evidence from an acceptable 

medical source.13 A licensed physician 

(a medical or osteopathic doctor) is the 

only acceptable medical source who can 

provide evidence establishing an MDI of 

IC. This acceptable medical source often 

is the person’s treating source(s) who 

makes the diagnosis of IC. A treating 

source(s) may be the person’s own 

physician or other acceptable medical 

source who provides, or has provided, 

medical evaluation or treatment and 

who has, or has had, an ongoing 

treatment relationship with the 

person.14

2. We generally will rely on the 

judgment of a licensed physician who 

has made a diagnosis of IC. The 

evidence must document that this 

physician reviewed the person’s 

medical history and conducted a 

physical examination, and that his or 

her diagnosis is not inconsistent with 

the other substantial evidence in the 

person’s case record.15 However, we 

cannot rely on the physician’s diagnosis 

alone to establish an MDI of IC. The 

physician may make a diagnosis of IC 

based only on the person’s reported 

symptoms, after examining the person 

and ruling out other diseases that could 

cause the symptoms. Thus, as 

previously mentioned, there must also 

be medical signs or laboratory findings 

to establish an MDI of IC. 

3. If we cannot establish that a person 

has an MDI of IC, but there is evidence 

of another MDI, we will not evaluate the 

impairment under this SSR. Instead, we 

will evaluate it under the rules that 

apply for that impairment. 

B. Symptoms. IC symptoms may vary 

in incidence, duration, and severity 

from person to person, and even in the 

same person. For example, a woman’s 

symptoms may worsen around the time 

of menstruation. Symptoms of IC 

include, but are not limited to: 

1. Pain. People who have IC report 

chronic bladder and pelvic pain, 

pressure, and discomfort. This pain may 

range from mild discomfort to extreme 

distress. The intensity of the pain may 

increase as the bladder fills and 

decrease as it empties. In addition to 

bladder and pelvic pain, people with IC 

may experience vaginal, testicular, 

penile, low back, or thigh pain. 

2. Urinary urgency and frequency. 

People who have IC may report an 

urgent need to urinate (urgency) or a 

frequent need to urinate (frequency), or 

both. Some people with severe cases of 

IC may need to void as often as 60 times 

per day, including nighttime urinary 

frequency (nocturia) with associated 

sleep disruption.16

3. Other symptoms. In addition to 

chronic pain and urinary urgency or 

frequency or both, the person may 

report additional IC symptoms, such as: 

• Suprapubic tenderness on physical 

examination; 

• Sexual dysfunction (including 

dyspareunia); 

• Sleep dysfunction; and 

• Chronic fatigue or tiredness. 

C. Medical signs. Medical signs can 

support a diagnosis of IC and help 

establish the MDI. These signs include 

the following, which can be detected 

during a medical procedure that 

stretches the bladder with fluid 

(cystoscopy under anesthesia with 

bladder distention): 17

1. Fibrosis (bladder-wall stiffening); 

2. Diffuse glomerulations (pinpoint 

bleeding caused by recurrent irritation) 

on the bladder wall; and 

3. Hunner’s ulcers (patches of broken 

skin) on the bladder wall.18

D. Laboratory findings. Laboratory test 

findings can also support a diagnosis of 

IC. We will make every reasonable effort 

to obtain the results of appropriate 

laboratory testing. However, we will not 

purchase complex, costly, or invasive 

tests. Some laboratory tests and findings 

are more widely used and accepted than 

others. The following laboratory 

findings can help establish an MDI of 

IC: 

1. Repeated sterile urine cultures 

while IC symptoms continue; 

2. Positive potassium sensitivity test 

(Parson’s test); 19 and 

3. Antiproliferative factor (APF) 

accumulation in the urine.20

E. Other signs and findings. Because 

of the ongoing research into the etiology 

and manifestations of IC, the medical 

criteria discussed above are only 

examples of signs and laboratory 

findings that help establish an MDI of 

IC; they are not all-inclusive. As 

medical research advances regarding IC, 

we may rely on other signs and 

laboratory findings to help establish an 

MDI of IC. For example, gene studies are 

exploring whether there are various 

mstockstill on DSK4VPTVN1PROD with NOTICES

14218 Federal Register / Vol. 80, No. 52 / Wednesday, March 18, 2015 / Notices 

21See 20 CFR 404.1528 and 416.928. 

22See 20 CFR 404.1513(d)(1), 416.913(d)(1); SSR 

06–03p: Titles II and XVI: Considering Opinions 

and Other Evidence from Sources Who Are Not 

‘‘Acceptable Medical Sources’’ in Disability Claims; 

Considering Decisions on Disability by Other 

Governmental and Nongovernmental Agencies, 71 

FR 45593 (2006) (also available at: http://

www.ssa.gov/OP_Home/rulings/di/01/SSR2006-03- 

di-01.html). 

23See 20 CFR 404.1513(d)(2–4) and 416.913(d)(2– 

4), and also SSR 06–03p. 

24See 20 CFR 404.1512(d) and 416.912(d). 

25To meet the statutory requirement for 

‘‘disability,’’ a person must have been unable to 

engage in any substantial gainful activity because of 

any medically determinable physical or mental 

impairment that is expected to result in death or 

that has lasted or can be expected to last for a 

continuous period of not less than 12 months. Thus, 

the existence of an impairment(s) for 12 continuous 

months is not controlling; rather, it is the existence 

of a disabling impairment that has lasted or can be 

expected to last for at least 12 months that meets 

the duration requirement of the Act. See 20 CFR 

404.1509 and 416.909. 

26See 20 CFR 404.1520b(c) and 416.920b(c). 

27See 20 CFR 404.1520b(c)(3), and 

416.920b(c)(3). The type of CE we purchase will 

depend on the nature of the person’s symptoms and 

the extent of the evidence already in the case 

record. For example, we may purchase a CE to help 

evaluate depression, anxiety, or other mental 

conditions associated with the person’s IC. We may 

purchase a CE without recontacting a person’s 

treating or other source if the source cannot provide 

the necessary information or the information is not 

available from the source. See 20 CFR 404.1519a(b) 

and 416.919a(b). 

28See 20 CFR 404.1520b(d) and 416.920b(d). 

29See 20 CFR 404.1520b and 416.920b. 

30See 20 CFR 404.1520, 416.920, and 416.924. 

subtypes of IC. Thus, we may document 

the existence of IC as an MDI with 

medical signs and laboratory findings 

other than those listed above, provided 

such evidence is consistent with 

medically accepted clinical practice and 

the other evidence in the case record. 

F. Mental conditions. People who 

have IC may report ongoing mental 

conditions directly associated with their 

IC. For example, a person may report 

having anxiety or depression associated 

with IC symptoms of chronic bladder 

and pelvic pain, and urinary urgency, 

frequency, or both. When these mental 

conditions are documented by mental 

status examination(s) or psychological 

testing, they may constitute medical 

signs or (in the case of psychological 

testing) laboratory findings that help 

establish an MDI of IC.21

III. How do we document IC? 

A. General. In cases of alleged IC, we 

generally need to have longitudinal 

evidence because symptoms, signs, and 

laboratory findings of IC may fluctuate 

in frequency and severity and may 

continue over a period of months or 

years. 

1. Longitudinal clinical records 

reflecting ongoing medical evaluation 

and treatment from the person’s medical 

sources, especially treating sources, are 

extremely helpful in documenting the 

presence of any signs or laboratory 

findings, as well as the person’s 

limitations over time. The longitudinal 

record should contain medical 

observations, information about 

treatment, the person’s response to 

treatment, and a detailed description of 

how the impairment affects the person’s 

ability to function. 

2. In addition to obtaining evidence 

from a physician, we may request 

evidence from other acceptable medical 

sources, such as psychologists, both to 

determine whether the person has 

another MDI(s) and to evaluate the 

severity and functional effects of IC in 

combination with other impairments the 

person may have. Under our regulations 

and SSR 06–03p, we also may consider 

evidence from other medical sources we 

do not consider acceptable medical 

sources to help us evaluate the severity 

and functional effects of the 

impairment(s).22 Nurse practitioners, 

physician assistants, and physical 

therapists are examples of these other 

medical sources. 

3. Information from nonmedical 

sources can also help us evaluate the 

severity of a person’s IC.23 This 

information may help us assess the 

person’s ability to function day-to-day 

and over time. It may also help us when 

we make findings about credibility of 

the person’s allegations about symptoms 

and their effects. Examples of 

nonmedical sources include: 

• Spouses, parents, siblings, other 

relatives, neighbors, friends, and clergy; 

• Past employers, rehabilitation 

counselors, and teachers; and 

• Statements from SSA and State 

agency personnel who interviewed the 

person. 

4. Before we make a determination 

whether or not the person is disabled, 

we will make every reasonable effort to 

develop his or her complete medical 

history and help the person get medical 

reports from his or her medical sources. 

Generally, we will request evidence 

from the person’s medical sources for 

the 12-month period preceding the 

month of application unless there is 

reason to believe that development of an 

earlier period is necessary, or unless the 

alleged onset of disability is less than 12 

months before the date of application.24

5. When the alleged onset of disability 

secondary to IC occurred less than 12 

months before adjudication, we must 

evaluate the medical evidence and 

project the degree of impairment 

severity that is likely to exist at the end 

of 12 months.25 Information about the 

person’s treatment and response to 

treatment, including any medical source 

opinions about the person’s prognosis at 

the end of 12 months, helps us decide 

whether to expect an MDI of IC to be of 

disabling severity for at least 12 

consecutive months. 

B. What do we do if there is insufficient 

evidence to determine whether the 

person has an MDI of IC or is disabled? 

1. When there is insufficient evidence 

for us to determine whether the person 

has an MDI of IC or is disabled, we may 

take one or more actions to try to resolve 

the insufficiency: 26

• We may recontact the person’s 

treating or other source(s) to see if the 

information we need is available; 

• We may request additional existing 

records from treating or other sources; 

• We may ask the person or others for 

more information; or 

• We may purchase a consultative 

examination (CE) at our expense.27

2. When we are unable to resolve an 

insufficiency in the evidence, and we 

need to determine whether the person 

has an MDI of IC or is disabled, we may 

make a determination or decision based 

on the evidence we have.28

C. How do we resolve conflicts in the 

evidence? Conflicting evidence in the 

medical record is not unusual in cases 

of IC due to the complicated diagnostic 

process involved. We will consider 

conflicting medical evidence in 

accordance with our rules.29

IV. How do we evaluate a person’s 

statements about his or her symptoms 

and functional limitations? 

Generally, we follow a two-step 

symptom evaluation process: 

A. First step of the symptom 

evaluation process. There must be 

medical signs or laboratory findings that 

show the person has an MDI(s) which 

we could reasonably expect to produce 

the pain or other symptoms alleged.30 If 

we find that a person has an MDI that 

we could reasonably expect to produce 

the alleged symptoms, the first step of 

our two-step process for evaluating 

symptoms is satisfied. 

B. Second step of the symptom 

evaluation process. After finding that 

the MDI could reasonably be expected 

to produce the alleged symptoms, we 

evaluate the intensity and persistence of 

the person’s symptoms and determine 

the extent to which they limit the 

person’s functional capacity for work. In 

evaluating the intensity, persistence, 

and functionally limiting effects of 

symptoms, we consider all of the 

evidence in the case record, including 

the person’s daily activities; 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 80, No. 52 / Wednesday, March 18, 2015 / Notices 14219 

31See 20 CFR 404.1529 and 416.929. See also SSR 

96–7p: Titles II and XVI: Evaluation of Symptoms 

in Disability Claims: Assessing the Credibility of an 

Individual’s Statements, 61 FR 34483 (1996) (also 

available at: http://www.socialsecurity.gov/OP_

Home/rulings/di/01/SSR96-07-di-01.html). 

32See 20 CFR 404.1520, 416.920, and 416.924. 

33See 20 CFR 404.1509 and 416.909. 

34See SSR 96–3p: Titles II and XVI: Considering 

Allegations of Pain and Other Symptoms in 

Determining Whether a Medically Determinable 

Impairment Is Severe, 61 FR 34468 (1996) (also 

available at: http://www.ssa.gov/OP_Home/rulings/

di/01/SSR96-03-di-01.html). 

35See 20 CFR, part 404, subpart P, appendix 1. 

36 In evaluating title XVI claims for disability 

benefits for people under age 18, we will consider 

whether the impairment(s) functionally equals the 

listings. See 20 CFR 416.926a. For example, the 

functional limitations of IC, by itself or in 

combination with another impairment(s), may 

establish an extreme limitation in one broad area of 

functioning (for example, attending and completing 

tasks) or marked limitation in two broad areas (for 

example, attending and completing tasks, and 

interacting or relating with others). 

37See sections 12.00 and 112.00 of 20 CFR, part 

404, subpart P, appendix 1. 

38See 20 CFR 404.1545(a) and 416.945(a), and 

also SSR 96–8p: Titles II and XVI: Assessing 

Residual Functional Capacity in Initial Claims, 61 

FR 34474 (1996) (also available at http://

www.ssa.gov/OP_Home/rulings/di/01/SSR96-08-di01.html). Our RFC assessments must consider the 

person’s maximum ability to do sustained work 

activities in an ordinary work setting on a regular 

and continuous basis. Generally, a ‘‘regular and 

continuous basis’’ means eight hours a day, for five 

days a week, or an equivalent work schedule of 40 

hours per week. In cases involving IC, chronic 

fatigue may affect the person’s physical and mental 

ability to sustain work activity, and this may be 

especially true in cases involving urinary 

frequency. 

39See 20 CFR 404.1529(d) and 416.929(d), and 

SSR 96–7p. 

40See 20 CFR 404.1520(h) and 416.920(h). 

41The fourth and fifth steps of the sequential 

evaluation process are not applicable to claims for 

benefits under title XVI for people under age 18. 

See 20 CFR 416.924. 

42See 20 CFR 404.1560–404.1569a and 416.960– 

416.969a, and SSR 11–2p: Titles II and XVI: 

Documenting and Evaluating Disability in Young 

Adults, 76 FR 56263 (2011) (also available at 

http://www.ssa.gov/OP_Home/rulings/di/01/

SSR2011-02-di-01.html). 

medications or other treatments the 

person uses, or has used, to alleviate 

symptoms; the nature and frequency of 

the person’s attempts to obtain medical 

treatment for symptoms; and statements 

by other people about the person’s 

symptoms. We will make a finding 

about the extent to which symptoms, 

such as pain, affect his or her capacity 

to perform basic work activities.31 When 

we need additional information to 

assess the person’s statements about 

symptoms and their effects, we will 

make every reasonable effort to obtain 

available information that could shed 

light on the person’s statements. 

V. How do we find a person disabled 

based on an MDI of IC? 

Once we establish that a person has 

an MDI of IC, we will consider this MDI 

in the sequential evaluation process to 

determine whether the person is 

disabled.32 As we explain in section VI 

below, we consider the severity of the 

impairment, whether the impairment 

meets or medically equals the 

requirements of a listed impairment, 

and whether the impairment prevents 

the person from doing his or her past 

relevant work or other work that exists 

in significant numbers in the national 

economy. 

VI. How do we use the sequential 

evaluation process to evaluate IC? 

We adjudicate claims involving IC 

using the sequential evaluation process, 

just as we do for any impairment. Once 

we find that an MDI(s) exists (see 

section II), we must establish the 

severity of the impairment(s) based on 

the totality of signs, symptoms, and 

laboratory findings, and the effects of 

the impairment(s), including any related 

symptoms, on the person’s ability to 

function. Additionally, several other 

disorders may share characteristics 

similar to those of IC. When there is 

evidence of the potential presence of 

another disorder that may adequately 

explain the person’s symptoms, it may 

be necessary to pursue additional 

medical or other development. As 

mentioned, if we cannot find that the 

person has an MDI of IC but there is 

evidence of another MDI, we will not 

evaluate the impairment under this SSR. 

Instead, we will evaluate it under the 

rules that apply for that impairment. 

A. Step 1. We consider the person’s 

work activity. If a person with IC is 

engaged in substantial gainful activity, 

we will find that he or she is not 

disabled. 

B. Step 2. If we find that a person with 

IC has an MDI that meets the duration 

requirement,33 and the person alleges 

pain and other symptoms consistent 

with IC, we must consider these 

symptoms in deciding whether the 

person’s impairment is ‘‘severe’’ at step 

2 of the sequential evaluation process, 

and at any later steps reached in the 

sequential evaluation process. If we find 

that the person’s pain, urinary urgency 

or urinary frequency, or other symptoms 

have more than a minimal effect on a 

person’s ability to perform basic work 

activities, we must find that the person 

has a ‘‘severe’’ impairment.34

C. Step 3. When we find that a person 

with IC has a severe MDI, we must 

proceed to step three and consider the 

medical severity of the impairment(s). 

At this step, we consider whether a 

person’s impairment(s) meets or equals 

in severity one of the impairments in 

the Listing of Impairments.35 IC is not 

a listed impairment; therefore, we 

cannot find that a person with IC alone 

has an impairment that meets a listing. 

However, we will compare the specific 

findings in each case to any pertinent 

listing to determine whether medical 

equivalence may exist.36 We also may 

find medical equivalence if the person 

has multiple impairments, including IC, 

none of which meets or medically 

equals the requirements of a listing, but 

the combination of impairments is 

medically equivalent in severity to a 

listed impairment. In cases in which a 

person with IC has psychological 

manifestations related to IC, we must 

consider whether the person’s 

impairment meets or equals the severity 

of any impairment in the mental 

disorders listings (see section IIF).37

D. Steps 4 and 5. For those 

impairments that do not meet or 

medically equal the severity of a listing, 

we must make an assessment of the 

person’s residual functional capacity 

(RFC). The RFC assessment must be 

based on all the relevant evidence in the 

record.38 In assessing RFC related to an 

MDI of IC, we must consider all of the 

person’s impairment-related symptoms 

in deciding how such symptoms may 

affect functional capacity.39 For 

example, many people with IC have 

chronic pelvic pain, which can affect 

the ability to focus and sustain attention 

on the task at hand. Nocturia may 

disrupt sleeping patterns and lead to 

drowsiness and lack of mental clarity 

during the day. Urinary frequency can 

necessitate trips to the bathroom as 

often as every 10 to 15 minutes, day and 

night. Consequently, some individuals 

with IC essentially may confine 

themselves to their homes. After we 

consider such impairment-related 

symptoms and we make our RFC 

assessment, our evaluation must 

proceed to the fourth step of the 

sequential evaluation process, unless an 

expedited process applies.40 If 

necessary, we then proceed to the fifth 

step of the sequential evaluation 

process.41 If we do not use an expedited 

process, we must determine whether the 

person’s impairment(s) precludes the 

performance of past relevant work 

(unless we determine that there was no 

past relevant work). If we determine that 

the person’s impairment(s) precludes 

performance of past relevant work or 

there was no past relevant work, we 

must make a finding about the person’s 

ability to perform other work. We must 

apply the usual vocational 

considerations in determining the 

person’s ability to perform other work.42

mstockstill on DSK4VPTVN1PROD with NOTICES

14220 Federal Register / Vol. 80, No. 52 / Wednesday, March 18, 2015 / Notices 

43See SSR 83–12: Title II and SVI: Capability To 

Do Other Work—The Medical-Vocational Rules as 

a Framework for Evaluating Exertional Limitations 

Within a Range of Work or Between Ranges of Work 

(available at http://www.socialsecurity.gov/OP_

Home/rulings/di/02/SSR83-12-di-02.html). 

44See SSR 85–15: Titles II and XVI: Capability To 

Do Other Work—Medical-Vocational Rules as a 

Framework for Evaluating Solely Nonexertional 

Impairments (available at: http://

www. social security. gov/OP_Home/rulings/di/02/

SSR85-15-di-02.html). 

45See SSR 83–12; SSR 83–14: Titles II and XVI: 

Capability To Do Other Work—The MedicalVocational Rules as a Framework for Evaluating a 

Combination of Exertional and Nonexertional 

Impairments (available at http://www.social

security.gov/OP_Home/rulings/di/02/SSR83-14-di02.html); SSR 85–15; and SSR 96–9p, Titles II and 

XVI: Determining Capability to Do Other Work— 

Implications of a Residual Functional Capacity for 

Less Than a Full Range of Sedentary Work, 61 FR 

34478 (July 2, 1996) (also available at http://www.

socialsecurity.gov/OP_Home/rulings/di/01/SSR96- 

09-di-01.html). 

46See 20 CFR 404.1594, 416.994, and 416.994a. 

1. Pain and other symptoms 

associated with IC may result in 

exertional limitations that prevent a 

person from doing a full range of 

unskilled work in one or more of the 

exertional categories in appendix 2 of 

subpart P of part 404 (appendix 2).43

People with IC may also have 

nonexertional physical or mental 

limitations because of their pain or 

other symptoms.44 Some may have 

environmental restrictions, which are 

also nonexertional. 

2. Exertional and nonexertional 

limitations resulting from IC may affect 

the person’s ability to perform routine 

movement and necessary physical 

activity in the work environment, such 

as sitting, standing, walking, lifting, 

carrying, pushing, and pulling. These 

limitations may also affect the person’s 

ability to do postural functions, such as 

climbing, balancing, stooping, and 

crouching, or they may affect the 

person’s ability to tolerate extreme heat, 

humidity, or hazards. 

3. Adjudicators must be alert to the 

possibility that there may be exertional 

or nonexertional (for example, postural 

or environmental) limitations that erode 

a person’s occupational base sufficiently 

to preclude the use of a rule in appendix 

2 to direct a decision. In such cases, 

adjudicators must use the rules in 

appendix 2 as a framework for decisionmaking and may need to consult a 

vocational resource.45

E. Continuing disability reviews. In 

those cases in which we find that a 

person has a disability based on IC, we 

will conduct an appropriate continuing 

disability review as required by law.46

For this review, we take into account 

relevant individual case facts, such as 

the combined severity of other chronic 

or static impairments, and the person’s 

vocational factors. 

Effective Date: This SSR is effective 

on March 18, 2015. 

Cross-References: SSR 82–63: Titles II 

and XVI: Medical-Vocational Profiles 

Showing an Inability To Make an 

Adjustment to Other Work; SSR 83–12: 

Titles II and XVI: Capability To Do 

Other Work—The Medical-Vocational 

Rules as a Framework for Evaluating 

Exertional Limitations Within a Range 

of Work or Between Ranges of Work; 

SSR 83–14: Titles II and XVI: Capability 

To Do Other Work—The MedicalVocational Rules as a Framework for 

Evaluating a Combination of Exertional 

and Nonexertional Impairments; SSR 

85–15: Titles II and XVI: Capability To 

Do Other Work—The MedicalVocational Rules as a Framework for 

Evaluating Solely Nonexertional 

Impairments; SSR 96–2p, Titles II and 

XVI: Giving Controlling Weight to 

Treating Source Medical Opinions; SSR 

96–3p, Titles II and XVI: Considering 

Allegations of Pain and Other 

Symptoms in Determining Whether a 

Medically Determinable Impairment Is 

Severe; SSR 96–4p, Titles II and XVI: 

Symptoms, Medically Determinable 

Physical and Mental Impairments, and 

Exertional and Nonexertional 

Limitations; SSR 96–5p, Titles II and 

XVI: Medical Source Opinions on Issues 

Reserved to the Commissioner; SSR 96– 

7p, Titles II and XVI: Evaluation of 

Symptoms in Disability Claims: 

Assessing the Credibility of an 

Individual’s Statements; SSR 96–8p, 

Titles II and XVI: Assessing Residual 

Functional Capacity in Initial Claims; 

SSR 96–9p, Titles II and XVI: 

Determining Capability to Do Other 

Work—Implications of a Residual 

Functional Capacity for Less Than a 

Full Range of Sedentary Work; SSR 06– 

03p, Titles II and XVI: Considering 

Opinions and Other Evidence from 

Sources Who Are Not ‘‘Acceptable 

Medical Sources’’ in Disability Claims; 

Considering Decisions on Disability by 

Other Governmental and 

Nongovernmental Agencies; SSR 12–2p, 

Titles II and XVI: Evaluation of 

Fibromyalgia; SSR 14–1p, Titles II and 

XVI: Evaluating Cases Involving Chronic 

Fatigue Syndrome (CFS); and Program 

Operations Manual System (POMS) DI 

22505.001, DI 22505.003, DI 24505.003, 

DI 24510.057, DI 24515.012, DI 

24515.061–DI 24515.063, DI 24515.066, 

DI 24515.067, DI 24515.075, DI 

24555.001, DI 25010.001, and DI 

25025.001. 

[FR Doc. 2015–05680 Filed 3–17–15; 8:45 am] 

BILLING CODE 4191–02–P 

DEPARTMENT OF TRANSPORTATION 

Federal Motor Carrier Safety 

Administration 

[Docket No. FMCSA–2013–0022] 

Qualification of Drivers; Exemption 

Applications; Vision 

AGENCY: Federal Motor Carrier Safety 

Administration (FMCSA), DOT. 

ACTION: Notice of renewal of 

exemptions; request for comments. 

SUMMARY: FMCSA announces its 

decision to renew the exemptions from 

the vision requirement in the Federal 

Motor Carrier Safety Regulations for 11 

individuals. FMCSA has statutory 

authority to exempt individuals from 

the vision requirement if the 

exemptions granted will not 

compromise safety. The Agency has 

concluded that granting these 

exemption renewals will provide a level 

of safety that is equivalent to or greater 

than the level of safety maintained 

without the exemptions for these 

commercial motor vehicle (CMV) 

drivers. 

DATES: This decision is effective April 

16, 2015. Comments must be received 

on or before April 17, 2015. 

ADDRESSES: You may submit comments 

bearing the Federal Docket Management 

System (FDMS) numbers: Docket No. 

[Docket No. FMCSA–2013–0022], using 

any of the following methods: 

• Federal eRulemaking Portal: Go to 

http://www.regulations.gov. Follow the 

on-line instructions for submitting 

comments. 

• Mail: Docket Management Facility; 

U.S. Department of Transportation, 1200 

New Jersey Avenue SE., West Building 

Ground Floor, Room W12–140, 

Washington, DC 20590–0001. 

• Hand Delivery or Courier: West 

Building Ground Floor, Room W12–140, 

1200 New Jersey Avenue SE., 

Washington, DC, between 9 a.m. and 5 

p.m., Monday through Friday, except 

Federal Holidays. 

• Fax: 1–202–493–2251. 

Instructions: Each submission must 

include the Agency name and the 

docket number for this notice. Note that 

DOT posts all comments received 

without change to http://

www.regulations.gov, including any 

personal information included in a 

comment. Please see the Privacy Act 

heading below. 

Docket: For access to the docket to 

read background documents or 

comments, go to http://

www.regulations.gov at any time or 

Room W12–140 on the ground level of 

mstockstill on DSK4VPTVN1PROD with NOTICES