Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34483

8At the hearings and appeals levels, vocational

experts (VEs) are vocational professionals who

provide impartial expert opinion during the

hearings and appeals process either by testifying or

by providing written responses to interrogatories. A

VE may be used before, during, or after a hearing.

Whenever a VE is used, the individual has the right

to review and respond to the VE evidence prior to

the issuance of a decision. The VE’s opinion is not

binding on an adjudicator, but must be weighed

along with all other evidence.

on the floor, doors ajar, or approaching

people or vehicles, there will be a

significant erosion of the sedentary

occupational base. These cases may

require the use of vocational resources.

Communicative limitations: Basic

communication is all that is needed to

do unskilled work. The ability to hear

and understand simple oral instructions

or to communicate simple information

is sufficient. If the individual retains

these basic communication abilities, the

unskilled sedentary occupational base

would not be significantly eroded in

these areas.

Environmental restrictions: An

‘‘environmental restriction’’ is an

impairment-caused need to avoid an

environmental condition in a

workplace. Definitions for various

workplace environmental conditions are

found in the SCO; e.g., ‘‘extreme cold’’

is exposure to nonweather-related cold

temperatures.

In general, few occupations in the

unskilled sedentary occupational base

require work in environments with

extreme cold, extreme heat, wetness,

humidity, vibration, or unusual hazards.

The ‘‘hazards’’ defined in the SCO are

considered unusual in unskilled

sedentary work. They include: moving

mechanical parts of equipment, tools, or

machinery; electrical shock; working in

high, exposed places; exposure to

radiation; working with explosives; and

exposure to toxic, caustic chemicals.

Even a need to avoid all exposure to

these conditions would not, by itself,

result in a significant erosion of the

occupational base.

Since all work environments entail

some level of noise, restrictions on the

ability to work in a noisy workplace

must be evaluated on an individual

basis. The unskilled sedentary

occupational base may or may not be

significantly eroded depending on the

facts in the case record. In such cases,

it may be especially useful to consult a

vocational resource.

Restrictions to avoid exposure to

odors or dust must also be evaluated on

an individual basis. The RFC

assessment must specify which

environments are restricted and state

the extent of the restriction; e.g.,

whether only excessive or even small

amounts of dust must be avoided.

Mental limitations or restrictions: A

substantial loss of ability to meet any

one of several basic work-related

activities on a sustained basis (i.e., 8

hours a day, 5 days a week, or an

equivalent work schedule), will

substantially erode the unskilled

sedentary occupational base and would

justify a finding of disability. These

mental activities are generally required

by competitive, remunerative, unskilled

work:

• Understanding, remembering, and

carrying out simple instructions.

• Making judgments that are

commensurate with the functions of

unskilled work—i.e., simple workrelated decisions.

• Responding appropriately to

supervision, co-workers and usual work

situations.

• Dealing with changes in a routine

work setting.

A less than substantial loss of ability

to perform any of the above basic work

activities may or may not significantly

erode the unskilled sedentary

occupational base. The individual’s

remaining capacities must be assessed

and a judgment made as to their effects

on the unskilled occupational base

considering the other vocational factors

of age, education, and work experience.

When an individual has been found to

have a limited ability in one or more of

these basic work activities, it may be

useful to consult a vocational resource.

Use of Vocational Resources

When the extent of erosion of the

unskilled sedentary occupational base is

not clear, the adjudicator may consult

various authoritative written resources,

such as the DOT, the SCO, the

Occupational Outlook Handbook, or

County Business Patterns.

In more complex cases, the

adjudicator may use the resources of a

vocational specialist or vocational

expert.8 The vocational resource may be

asked to provide any or all of the

following: An analysis of the impact of

the RFC upon the full range of sedentary

work, which the adjudicator may

consider in determining the extent of

the erosion of the occupational base,

examples of occupations the individual

may be able to perform, and citations of

the existence and number of jobs in

such occupations in the national

economy.

Effective Date: This Ruling is effective

on the date of its publication in the

Federal Register.

Cross-References: SSR 86–8, ‘‘Titles II

and XVI: The Sequential Evaluation

Process’’ (C.E. 1986, p. 78), SSR 83–10,

‘‘Titles II and XVI: Determining

Capability to Do Other Work—The

Medical-Vocational Rules of Appendix

2’’ (C.E. 1981–1985, p. 516), 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’’

(C.E. 1981–1985, p. 529), SSR 83–14,

‘‘Titles II and XVI: Capability to Do

Other Work—The Medical-Vocational

Rules as a Framework for Evaluating a

Combination of Exertional and

Nonexertional Impairments’’ (C.E.

1981–1985, p. 535), SSR 85–15, ‘‘Titles

II and XVI: Capability to Do Other

Work—The Medical-Vocational Rules as

a Framework for Evaluating Solely

Nonexertional Impairments’’ (C.E.

1981–1985, p. 543), SSR–96 8p, ‘‘Titles

II and XVI: Assessing Residual

Functional Capacity in Initial Claims;’’

Program Operations Manual System,

sections DI 24510.001, DI 24510.005, DI

24510.010, DI 24510.050, DI 24515.061,

DI 25001.001, DI 25010.001, DI

25020.005, DI 25020.010, DI 25020.015,

DI 25025.001 and DI 28005.015; and

Hearings, Appeals, and Litigation Law

Manual, sections I–2–548 and I–2–550.

[FR Doc. 96–16692 Filed 7–01–96; 8:45 am]

BILLING CODE 4190–29–P

[Social Security Ruling (SSR) 96–7p]

Titles II and XVI: Evaluation of

Symptoms in Disability Claims:

Assessing the Credibility of an

Individual’s Statements

AGENCY: Social Security Administration.

ACTION: Notice of Social Security ruling.

SUMMARY: In accordance with 20 CFR

422.406(b)(1), the Commissioner of

Social Security gives notice of Social

Security Ruling 96–7p. This Ruling

clarifies when the evaluation of

symptoms, including pain, under 20

CFR 404.1529 and 416.929 requires a

finding about the credibility of an

individual’s statements about pain or

other symptom(s) and its functional

effects; explains the factors to be

considered in assessing the credibility

of the individual’s statements about

symptoms; and states the importance of

explaining the reasons for the finding

about the credibility of the individual’s

statements in the disability

determination or decision. This Ruling

also incorporates and elaborates upon

the policy interpretation and procedures

in SSR 95–5p, ‘‘Titles II and XVI:

Considering Allegations of Pain and

Other Symptoms in Residual Functional

Capacity and Individualized Functional

Assessments and Explaining

Conclusions Reached’’ (published in the
34484 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

1For clarity, the discussions in this Ruling refer

only to claims of individuals claiming disability

benefits under title II and individuals age 18 or

older claiming disability benefits under title XVI.

However, the same basic principles with regard to

determining whether statements about symptoms

are credible also apply to claims of individuals

under age 18 claiming disability benefits under title

XVI.

2For an individual under age 18 claiming

disability benefits under title XVI who is unable to

adequately describe his or her symptom(s), the

adjudicator will accept as a statement of this

symptom(s) the description given by the person

most familiar with the individual, such as a parent,

other relative, or guardian. 20 CFR 416.928(a).

3The adjudicator must develop evidence

regarding the possibility of a medically

determinable mental impairment when the record

contains information to suggest that such an

impairment exists, and the individual alleges pain

or other symptoms, but the medical signs and

laboratory findings do not substantiate any physical

impairment(s) capable of producing the pain or

other symptoms.

Federal Register on October 31, 1995, at

60 FR 55406). Consequently, this Ruling

supersedes SSR 95–5p.

EFFECTIVE DATE: July 2, 1996.

FOR FURTHER INFORMATION CONTACT:

Joanne K. Castello, Division of

Regulations and Rulings, Social Security

Administration, 6401 Security

Boulevard, Baltimore, MD 21235, (410)

965–1711.

SUPPLEMENTARY INFORMATION: Although

we are not required to do so pursuant

to 5 U.S.C. 552 (a)(1) and (a)(2), we are

publishing this Social Security Ruling

in accordance with 20 CFR

422.406(b)(1).

Social Security Rulings make

available to the public precedential

decisions relating to the Federal old-age,

survivors, disability, supplemental

security income, and black lung benefits

programs. Social Security Rulings may

be based on case decisions made at all

administrative levels of adjudication,

Federal court decisions, Commissioner’s

decisions, opinions of the Office of the

General Counsel, and other policy

interpretations of the law and

regulations.

Although Social Security Rulings do

not have the force and effect of the law

or regulations, they are binding on all

components of the Social Security

Administration, in accordance with 20

CFR 422.406(b)(1), and are to be relied

upon as precedents in adjudicating

cases.

If this Social Security Ruling is later

superseded, modified, or rescinded, we

will publish a notice in the Federal

Register to that effect.

(Catalog of Federal Domestic Assistance,

Programs 96.001 Social Security—Disability

Insurance; 96.002 Social Security—

Retirement Insurance; 96.004 Social

Security—Survivors Insurance; 96.005

Special Benefits for Disabled Coal Miners;

96.006 Supplemental Security Income.)

Dated: June 7, 1996.

Shirley S. Chater,

Commissioner of Social Security.

Policy Interpretation Ruling—Titles II

and XVI: Evaluation of Symptoms in

Disability Claims: Assessing the

Credibility of an Individual’s Statements

This Ruling supersedes Social

Security Ruling (SSR) 95–5p, ‘‘Titles II

and XVI: Considering Allegations of

Pain and Other Symptoms in Residual

Functional Capacity and Individualized

Functional Assessments and Explaining

Conclusions Reached.’’

Purpose: The purpose of this Ruling is

to clarify when the evaluation of

symptoms, including pain, under 20

CFR 404.1529 and 416.929 requires a

finding about the credibility of an

individual’s statements about pain or

other symptom(s) and its functional

effects; to explain the factors to be

considered in assessing the credibility

of the individual’s statements about

symptoms; and to state the importance

of explaining the reasons for the finding

about the credibility of the individual’s

statements in the disability

determination or decision.1 In

particular, this Ruling emphasizes that:

1. No symptom or combination of

symptoms can be the basis for a finding

of disability, no matter how genuine the

individual’s complaints may appear to

be, unless there are medical signs and

laboratory findings demonstrating the

existence of a medically determinable

physical or mental impairment(s) that

could reasonably be expected to

produce the symptoms.

2. When the existence of a medically

determinable physical or mental

impairment(s) that could reasonably be

expected to produce the symptoms has

been established, the intensity,

persistence, and functionally limiting

effects of the symptoms must be

evaluated to determine the extent to

which the symptoms affect the

individual’s ability to do basic work

activities. This requires the adjudicator

to make a finding about the credibility

of the individual’s statements about the

symptom(s) and its functional effects.

3. Because symptoms, such as pain,

sometimes suggest a greater severity of

impairment than can be shown by

objective medical evidence alone, the

adjudicator must carefully consider the

individual’s statements about symptoms

with the rest of the relevant evidence in

the case record in reaching a conclusion

about the credibility of the individual’s

statements if a disability determination

or decision that is fully favorable to the

individual cannot be made solely on the

basis of objective medical evidence.

4. In determining the credibility of the

individual’s statements, the adjudicator

must consider the entire case record,

including the objective medical

evidence, the individual’s own

statements about symptoms, statements

and other information provided by

treating or examining physicians or

psychologists and other persons about

the symptoms and how they affect the

individual, and any other relevant

evidence in the case record. An

individual’s statements about the

intensity and persistence of pain or

other symptoms or about the effect the

symptoms have on his or her ability to

work may not be disregarded solely

because they are not substantiated by

objective medical evidence.

5. It is not sufficient for the

adjudicator to make a single, conclusory

statement that ‘‘the individual’s

allegations have been considered’’ or

that ‘‘the allegations are (or are not)

credible.’’ It is also not enough for the

adjudicator simply to recite the factors

that are described in the regulations for

evaluating symptoms. The

determination or decision must contain

specific reasons for the finding on

credibility, supported by the evidence

in the case record, and must be

sufficiently specific to make clear to the

individual and to any subsequent

reviewers the weight the adjudicator

gave to the individual’s statements and

the reasons for that weight.

Citations (Authority): Sections 216(i),

223(d), and 1614(a)(3) of the Social

Security Act, as amended; Regulations

No. 4, sections 404.1528(a), 404.1529,

and 404.1569a; and Regulations No. 16,

sections 416.928(a), 416.929, and

416.969a.

Introduction: A symptom is an

individual’s own description of his or

her physical or mental impairment(s).2

Under the regulations, an individual’s

statement(s) about his or her symptoms

is not enough in itself to establish the

existence of a physical or mental

impairment or that the individual is

disabled.

The regulations describe a two-step

process for evaluating symptoms, such

as pain, fatigue, shortness of breath,

weakness, or nervousness:

• First, the adjudicator must consider

whether there is an underlying

medically determinable physical or

mental impairment(s)—i.e., an

impairment(s) that can be shown by

medically acceptable clinical and

laboratory diagnostic techniques—that

could reasonably be expected to

produce the individual’s pain or other

symptoms.3 The finding that an
Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34485

4 In determining whether the impairment(s) of an

individual claiming disability benefits under title II

or an individual age 18 or older claiming disability

benefits under title XVI is medically equivalent to

a listed impairment in appendix 1 of subpart P of

20 CFR Part 404, the adjudicator will not substitute

allegations of pain or other symptoms for a missing

or deficient sign or laboratory finding to raise the

severity of the individual’s impairment(s) to that of

a listed impairment. 20 CFR 404.1529(d)(3) and

416.929(d)(3). In determining whether the

impairment(s) of an individual under age 18

claiming disability benefits under title XVI is

equivalent to a listed impairment, if the adjudicator

cannot find equivalence based on medical evidence

only, the adjudicator will consider pain or another

symptom(s) under 20 CFR 416.926a(b)(3) in

determining whether the individual has an

impairment(s) that results in overall functional

limitations that are the same as the disabling

functional consequences of a listed impairment. 20

CFR 416.929(d)(3).

individual’s impairment(s) could

reasonably be expected to produce the

individual’s pain or other symptoms

does not involve a determination as to

the intensity, persistence, or

functionally limiting effects of the

individual’s symptoms. If there is no

medically determinable physical or

mental impairment(s), or if there is a

medically determinable physical or

mental impairment(s) but the

impairment(s) could not reasonably be

expected to produce the individual’s

pain or other symptoms, the symptoms

cannot be found to affect the

individual’s ability to do basic work

activities.

• Second, once an underlying

physical or mental impairment(s) that

could reasonably be expected to

produce the individual’s pain or other

symptoms has been shown, the

adjudicator must evaluate the intensity,

persistence, and limiting effects of the

individual’s symptoms to determine the

extent to which the symptoms limit the

individual’s ability to do basic work

activities. For this purpose, whenever

the individual’s statements about the

intensity, persistence, or functionally

limiting effects of pain or other

symptoms are not substantiated by

objective medical evidence, the

adjudicator must make a finding on the

credibility of the individual’s statements

based on a consideration of the entire

case record. This includes the medical

signs and laboratory findings, the

individual’s own statements about the

symptoms, any statements and other

information provided by treating or

examining physicians or psychologists

and other persons about the symptoms

and how they affect the individual, and

any other relevant evidence in the case

record. This requirement for a finding

on the credibility of the individual’s

statements about symptoms and their

effects is reflected in 20 CFR

404.1529(c)(4) and 416.929(c)(4). These

provisions of the regulations provide

that an individual’s symptoms,

including pain, will be determined to

diminish the individual’s capacity for

basic work activities to the extent that

the individual’s alleged functional

limitations and restrictions due to

symptoms can reasonably be accepted

as consistent with the objective medical

evidence and other evidence in the case

record.

When additional information is

needed to assess the credibility of the

individual’s statements about symptoms

and their effects, the adjudicator must

make every reasonable effort to obtain

available information that could shed

light on the credibility of the

individual’s statements. In recognition

of the fact that an individual’s

symptoms can sometimes suggest a

greater level of severity of impairment

than can be shown by the objective

medical evidence alone, 20 CFR

404.1529(c) and 416.929(c) describe the

kinds of evidence, including the factors

below, that the adjudicator must

consider in addition to the objective

medical evidence when assessing the

credibility of an individual’s statements:

1. The individual’s daily activities;

2. The location, duration, frequency,

and intensity of the individual’s pain or

other symptoms;

3. Factors that precipitate and

aggravate the symptoms;

4. The type, dosage, effectiveness, and

side effects of any medication the

individual takes or has taken to alleviate

pain or other symptoms;

5. Treatment, other than medication,

the individual receives or has received

for relief of pain or other symptoms;

6. Any measures other than treatment

the 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 the

individual’s functional limitations and

restrictions due to pain or other

symptoms.

Once the adjudicator has determined

the extent to which the individual’s

symptoms limit the individual’s ability

to do basic work activities by making a

finding on the credibility of the

individual’s statements, the impact of

the symptoms on the individual’s ability

to function must be considered along

with the objective medical and other

evidence, first in determining whether

the individual’s impairment or

combination of impairments is ‘‘severe’’

at step 2 of the sequential evaluation

process for determining disability and,

as necessary, at each subsequent step of

the process.4 (See SSR 96–3p, ‘‘Titles II

and XVI: Considering Allegations of

Pain and Other Symptoms in

Determining Whether a Medically

Determinable Impairment is Severe,’’

and SSR 96–8p, ‘‘Titles II and XVI:

Assessing Residual Functional Capacity

in Initial Claims.’’)

Policy Interpretation: A symptom is

an individual’s own description of his

or her physical or mental impairment(s).

Once the existence of a medically

determinable physical or mental

impairment(s) that could reasonably be

expected to produce pain or other

symptoms has been established,

adjudicators must recognize that

individuals may experience their

symptoms differently and may be

limited by their symptoms to a greater

or lesser extent than other individuals

with the same medical impairments and

the same medical signs and laboratory

findings. Because symptoms, such as

pain, sometimes suggest a greater

severity of impairment than can be

shown by objective medical evidence

alone, any statements of the individual

concerning his or her symptoms must be

carefully considered if a fully favorable

determination or decision cannot be

made solely on the basis of objective

medical evidence.

If an individual’s statements about

pain or other symptoms are not

substantiated by the objective medical

evidence, the adjudicator must consider

all of the evidence in the case record,

including any statements by the

individual and other persons

concerning the individual’s symptoms.

The adjudicator must then make a

finding on the credibility of the

individual’s statements about symptoms

and their functional effects.

Credibility

In general, the extent to which an

individual’s statements about symptoms

can be relied upon as probative

evidence in determining whether the

individual is disabled depends on the

credibility of the statements. In basic

terms, the credibility of an individual’s

statements about pain or other

symptoms and their functional effects is

the degree to which the statements can

be believed and accepted as true. When

evaluating the credibility of an

individual’s statements, the adjudicator

must consider the entire case record and

give specific reasons for the weight

given to the individual’s statements.

The finding on the credibility of the

individual’s statements cannot be based

on an intangible or intuitive notion

about an individual’s credibility. The

reasons for the credibility finding must

be grounded in the evidence and

articulated in the determination or
34486 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

5The seven factors are also set out in the

‘‘Introduction,’’ above.

decision. It is not sufficient to make a

conclusory statement that ‘‘the

individual’s allegations have been

considered’’ or that ‘‘the allegations are

(or are not) credible.’’ It is also not

enough for the adjudicator simply to

recite the factors that are described in

the regulations for evaluating

symptoms. The determination or

decision must contain specific reasons

for the finding on credibility, supported

by the evidence in the case record, and

must be sufficiently specific to make

clear to the individual and to any

subsequent reviewers the weight the

adjudicator gave to the individual’s

statements and the reasons for that

weight. This documentation is

necessary in order to give the individual

a full and fair review of his or her claim,

and in order to ensure a well-reasoned

determination or decision.

In making a finding about the

credibility of an individual’s statements,

the adjudicator need not totally accept

or totally reject the individual’s

statements. Based on a consideration of

all of the evidence in the case record,

the adjudicator may find all, only some,

or none of an individual’s allegations to

be credible. The adjudicator may also

find an individual’s statements, such as

statements about the extent of

functional limitations or restrictions due

to pain or other symptoms, to be

credible to a certain degree. For

example, an adjudicator may find

credible an individual’s statement that

the abilities to lift and carry are affected

by symptoms, but find only partially

credible the individual’s statements as

to the extent of the functional

limitations or restrictions due to

symptoms; i.e., that the individual’s

abilities to lift and carry are

compromised, but not to the degree

alleged. Conversely, an adjudicator may

find credible an individual’s statement

that symptoms limit his or her ability to

concentrate, but find that the limitation

is greater than that stated by the

individual.

Moreover, a finding that an

individual’s statements are not credible,

or not wholly credible, is not in itself

sufficient to establish that the

individual is not disabled. All of the

evidence in the case record, including

the individual’s statements, must be

considered before a conclusion can be

made about disability.

Factors in Evaluating Credibility

Assessment of the credibility of an

individual’s statements about pain or

other symptoms and about the effect the

symptoms have on his or her ability to

function must be based on a

consideration of all of the evidence in

the case record. This includes, but is not

limited to:

• The medical signs and laboratory

findings;

• Diagnosis, prognosis, and other

medical opinions provided by treating

or examining physicians or

psychologists and other medical

sources; and

• Statements and reports from the

individual and from treating or

examining physicians or psychologists

and other persons about the individual’s

medical history, treatment and

response, prior work record and efforts

to work, daily activities, and other

information concerning the individual’s

symptoms and how the symptoms affect

the individual’s ability to work.

The adjudicator must also consider

any observations about the individual

recorded by Social Security

Administration (SSA) employees during

interviews, whether in person or by

telephone. In instances where the

individual attends an administrative

proceeding conducted by the

adjudicator, the adjudicator may also

consider his or her own recorded

observations of the individual as part of

the overall evaluation of the credibility

of the individual’s statements.

Consideration of the individual’s

statements and the statements and

reports of medical sources and other

persons with regard to the seven factors

listed in the regulations,5 along with any

other relevant information in the case

record, including the information

described above, will provide the

adjudicator with an overview of the

individual’s subjective complaints. The

adjudicator must then evaluate all of

this information and draw appropriate

inferences and conclusions about the

credibility of the individual’s

statements.

The following sections provide

additional guidelines for the adjudicator

to consider when evaluating the

credibility of an individual’s statements.

Consistency

One strong indication of the

credibility of an individual’s statements

is their consistency, both internally and

with other information in the case

record. The adjudicator must consider

such factors as:

• The degree to which the

individual’s statements are consistent

with the medical signs and laboratory

findings and other information provided

by medical sources, including

information about medical history and

treatment.

• The consistency of the individual’s

own statements. The adjudicator must

compare statements made by the

individual in connection with his or her

claim for disability benefits with

statements he or she made under other

circumstances, when such information

is in the case record. Especially

important are statements made to

treating or examining medical sources

and to the ‘‘other sources’’ defined in 20

CFR 404.1513(e) and 416.913(e). The

adjudicator must also look at statements

the individual made to SSA at each

prior step of the administrative review

process and in connection with any

concurrent claim or, when available,

prior claims for disability benefits under

titles II and XVI. Likewise, the case

record may contain statements the

individual made 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. However, the

lack of consistency between an

individual’s statements and other

statements that he or she has made at

other times does not necessarily mean

that the individual’s statements are not

credible. Symptoms may vary in their

intensity, persistence, and functional

effects, or may worsen or improve with

time, and this may explain why the

individual does not always allege the

same intensity, persistence, or

functional effects of his or her

symptoms. Therefore, the adjudicator

will need to review the case record to

determine whether there are any

explanations for any variations in the

individual’s statements about symptoms

and their effects.

• The consistency of the individual’s

statements with other information in the

case record, including reports and

observations by other persons

concerning the individual’s daily

activities, behavior, and efforts to work.

This includes any observations recorded

by SSA employees in interviews and

observations recorded by the

adjudicator in administrative

proceedings.

Medical Evidence

Symptoms cannot be measured

objectively through clinical or

laboratory diagnostic techniques;

however, their effects can often be

clinically observed. The regulations at

20 CFR 404.1529(c)(2) and 416.929(c)(2)

provide that objective medical evidence

‘‘is a useful indicator to assist us in

making reasonable conclusions about

the intensity and persistence of’’ an

individual’s symptoms and the effects

those symptoms may have on the
Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34487

6The adjudicator must also remember that

medical treatment need not always be specifically

for the relief of a symptom. Often, treatment will

be aimed at ameliorating the underlying medical

condition which, in turn, may result in

improvement in symptoms. The treatment may also

cause symptoms as a side effect.

individual’s ability to function. The

examples in the regulations (reduced

joint motion, muscle spasm, sensory

deficit, and motor disruption) illustrate

findings that may result from, or be

associated with, the symptom of pain.

When present, these findings tend to

lend credibility to an individual’s

allegations about pain or other

symptoms and their functional effects.

When there are medical signs and

laboratory findings demonstrating the

existence of a medically determinable

physical or mental impairment(s) that

could reasonably be expected to

produce the pain or other symptoms,

the adjudicator must always attempt to

obtain any available objective medical

evidence concerning the intensity and

persistence of the pain or other

symptoms, and, when such evidence is

obtained, must consider it in evaluating

the individual’s statements. However,

allegations concerning the intensity and

persistence of pain or other symptoms

may not be disregarded solely because

they are not substantiated by objective

medical evidence. A report of negative

findings from the application of

medically acceptable clinical and

laboratory diagnostic techniques is one

of the many factors that appropriately

are to be considered in the overall

assessment of credibility. However, the

absence of objective medical evidence

supporting an individual’s statements

about the intensity and persistence of

pain or other symptoms is only one

factor that the adjudicator must consider

in assessing an individual’s credibility

and must be considered in the context

of all the evidence.

Over time, there may also be medical

signs and laboratory findings that,

though not directly supporting or

refuting statements about the intensity

or persistence of pain or other

symptoms, demonstrate worsening or

improvement of the underlying medical

condition. Such signs and findings may

also help an adjudicator to draw

appropriate inferences about the

credibility of an individual’s statements.

Apart from the medical signs and

laboratory findings, the medical

evidence, especially a longitudinal

medical record, can be extremely

valuable in the adjudicator’s evaluation

of an individual’s statements about pain

or other symptoms.

Important information about

symptoms recorded by medical sources

and reported in the medical evidence

may include:

• Onset, description of the character

and location of the symptoms,

precipitating and aggravating factors,

frequency and duration, course over

time (e.g., whether worsening,

improving, or static), and daily

activities. Very often, this information

will have been obtained by the medical

source from the individual and may be

compared with the individual’s other

statements in the case record. However,

the evidence provided by a medical

source may also contain medical

opinions of the source about the

individual’s symptoms and their effects,

and such opinions must be weighed

applying the factors in 20 CFR 404.1527

and 416.927.

• A longitudinal record of any

treatment and its success or failure,

including any side effects of medication.

• Indications of other impairments,

such as potential mental impairments,

that could account for the allegations.

Although longitudinal records

showing regular contact with a treating

source are the most desirable,

longitudinal medical records can be

valuable even when they are not treating

source records. For example, an

individual may receive treatment at a

clinic and see different physicians, but

the clinic records may still show a

longitudinal history of complaints and

attempts at relief.

Medical Treatment History

In general, a longitudinal medical

record demonstrating an individual’s

attempts to seek medical treatment for

pain or other symptoms and to follow

that treatment once it is prescribed

lends support to an individual’s

allegations of intense and persistent

pain or other symptoms for the purposes

of judging the credibility of the

individual’s statements. Persistent

attempts by the individual to obtain

relief of pain or other symptoms, such

as by increasing medications, trials of a

variety of treatment modalities in an

attempt to find one that works or that

does not have side effects, referrals to

specialists, or changing treatment

sources may be a strong indication that

the symptoms are a source of distress to

the individual and generally lend

support to an individual’s allegations of

intense and persistent symptoms.6

On the other hand, the individual’s

statements may be less credible if the

level or frequency of treatment is

inconsistent with the level of

complaints, or if the medical reports or

records show that the individual is not

following the treatment as prescribed

and there are no good reasons for this

failure. However, the adjudicator must

not draw any inferences about an

individual’s symptoms and their

functional effects from a failure to seek

or pursue regular medical treatment

without first considering any

explanations that the individual may

provide, or other information in the case

record, that may explain infrequent or

irregular medical visits or failure to seek

medical treatment. The adjudicator may

need to recontact the individual or

question the individual at the

administrative proceeding in order to

determine whether there are good

reasons the individual does not seek

medical treatment or does not pursue

treatment in a consistent manner. The

explanations provided by the individual

may provide insight into the

individual’s credibility. For example:

• The individual’s daily activities

may be structured so as to minimize

symptoms to a tolerable level or

eliminate them entirely, avoiding

physical or mental stressors that would

exacerbate the symptoms. The

individual may be living with the

symptoms, seeing a medical source only

as needed for periodic evaluation and

renewal of medications.

• The individual’s symptoms may not

be severe enough to prompt the

individual to seek ongoing medical

attention or may be relieved with overthe-counter medications.

• The individual may not take

prescription medication because the

side effects are less tolerable than the

symptoms.

• The individual may be unable to

afford treatment and may not have

access to free or low-cost medical

services.

• The individual may have been

advised by a medical source that there

is no further, effective treatment that

can be prescribed and undertaken that

would benefit the individual.

• Medical treatment may be contrary

to the teaching and tenets of the

individual’s religion.

Other Sources of Information

Other sources may provide

information from which inferences and

conclusions may be drawn about the

credibility of the individual’s

statements. Such sources may provide

information about the seven factors

listed in the regulations and may be

especially helpful in establishing a

longitudinal record. Examples of such

sources include public and private

agencies, other practitioners, and

nonmedical sources such as family and

friends.
34488 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

Observations of the Individual

In instances in which the adjudicator

has observed the individual, the

adjudicator is not free to accept or reject

the individual’s complaints solely on

the basis of such personal observations,

but should consider any personal

observations in the overall evaluation of

the credibility of the individual’s

statements.

In evaluating the credibility of the

individual’s statements, the adjudicator

must also consider any observations

recorded by SSA personnel who

previously interviewed the individual,

whether in person or by telephone.

Consideration of Findings by State

Agency and Other Program Physicians

and Psychologists at the Administrative

Law Judge and Appeals Council Levels

of Administrative Review

Under 20 CFR 404.1527(f) and

416.927(f), administrative law judges

and the Appeals Council are required to

consider findings of fact by State agency

medical and psychological consultants

and other program physicians and

psychologists about the existence and

severity of an individual’s

impairment(s), including the existence

and severity of any symptoms, as

opinions of nonexamining physicians

and psychologists. Administrative law

judges and the Appeals Council are not

bound by any State agency findings, but

they may not ignore these opinions and

must explain the weight given to the

opinions in their decisions. Therefore, if

the case record includes a finding by a

State agency medical or psychological

consultant or other program physician

or psychologist on the credibility of the

individual’s statements about

limitations or restrictions due to

symptoms, the adjudicator at the

administrative law judge or Appeals

Council level of administrative review

must consider and weigh this opinion of

a nonexamining source under the

applicable rules in 20 CFR 404.1527 and

416.927 and must explain the weight

given to the opinion in the decision.

(See SSR 96–6p, ‘‘Titles II and XVI:

Consideration of Administrative

Findings of Fact by State Agency

Medical and Psychological Consultants

and Other Program Physicians and

Psychologists at the Administrative Law

Judge and Appeals Council Levels of

Administrative Review; Medical

Equivalence.’’)

Effective Date: This Ruling is effective

on July 2, 1996.

Cross-References: SSR 96–3p, ‘‘Titles

II and XVI: Considering Allegations of

Pain and Other Symptoms in

Determining Whether a Medically

Determinable Impairment is Severe,’’

SSR 96–8p, ‘‘Titles II and XVI:

Assessing Residual Functional Capacity

in Initial Claims,’’ SSR 96–6p, ‘‘Titles II

and XVI: Consideration of

Administrative Findings of Fact by State

Agency Medical and Psychological

Consultants and Other Program

Physicians and Psychologists at the

Administrative Law Judge and Appeals

Council Levels of Administrative

Review; Medical Equivalence;’’ and

Program Operations Manual System,

sections DI 24515.061 and DI

24515.064.B.3.

[FR Doc. 96–16690 Filed 7–1–96; 8:45 am]

BILLING CODE 4190–29–P

Social Security Ruling (SSR) 96–4p.

Titles II and XVI: Symptoms, Medically

Determinable Physical and Mental

Impairments, and Exertional and

Nonexertional Limitations

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling.

SUMMARY: In accordance with 20 CFR

422.406(b)(1), the Commissioner of

Social Security gives notice of Social

Security Ruling 96–4p. This Ruling

clarifies the Social Security

Administration’s longstanding policy on

the evaluation of symptoms in the

adjudication of claims for disability

benefits under Title II, Federal Old-Age,

Survivors, and Disability Insurance

Benefits, and Title XVI, Supplemental

Security Income for the Aged, Blind,

and Disabled, of the Social Security Act.

EFFECTIVE DATE: July 2, 1996.

FOR FURTHER INFORMATION CONTACT:

Joanne K. Castello, Division of

Regulations and Rulings, Social Security

Administration, 6401 Security

Boulevard, Baltimore, MD 21235, (410)

965–1711.

SUPPLEMENTARY INFORMATION: Although

we are not required to do so pursuant

to 5 U.S.C. 552(a)(1) and (a)(2), we are

publishing this Social Security Ruling

in accordance with 20 CFR

422.406(b)(1).

Social Security Rulings make

available to the public precedential

decisions relating to the Federal old-age,

survivors, disability, supplemental

security income, and black lung benefits

programs. Social Security Rulings may

be based on case decisions made at all

administrative levels of adjudication,

Federal court decisions, Commissioner’s

decisions, opinions of the Office of the

General Counsel, and other policy

interpretations of the law and

regulations.

Although Social Security Rulings do

not have the force and effect of the law

or regulations, they are binding on all

components of the Social Security

Administration, in accordance with 20

CFR 422.406(b)(1), and are to be relied

upon as precedents in adjudicating

cases.

If this Social Security Ruling is later

superseded, modified, or rescinded, we

will publish a notice in the Federal

Register to that effect.

(Catalog of Federal Domestic Assistance,

Programs 96.001 Social Security—Disability

Insurance; 96.002 Social Security—

Retirement Insurance; 96.004 Social SecuritySurvivors Insurance; 96.005 Special Benefits

for Disabled Coal Miners; 96.006

Supplemental Security Income)

Dated: June 7, 1996.

Shirley S. Chater,

Commissioner of Social Security.

Policy Interpretation Ruling—Titles II

and XVI: Symptoms, Medically

Determinable Physical and Mental

Impairments, and Exertional and

Nonexertional Limitations

Purpose: The purpose of this Ruling is

to clarify longstanding policy of the

Social Security Administration on the

evaluation of symptoms in the

adjudication of claims for disability

benefits under title II and title XVI of

the Social Security Act (the Act). In

particular, this Ruling emphasizes that:

1. A ‘‘symptom’’ is not a ‘‘medically

determinable physical or mental

impairment’’ and no symptom by itself

can establish the existence of such an

impairment.

2. In the absence of a showing that

there is a ‘‘medically determinable

physical or mental impairment,’’ an

individual must be found not disabled

at step 2 of the sequential evaluation

process. No symptom or combination of

symptoms can be the basis for a finding

of disability, no matter how genuine the

individual’s complaints may appear to

be, unless there are medical signs and

laboratory findings demonstrating the

existence of a medically determinable

physical or mental impairment.

3. The terms ‘‘exertional’’ and

‘‘nonexertional’’ in the regulations

describe types of functional limitations

or restrictions resulting from a

medically determinable physical or

mental impairment; i.e., exertional

limitations affect an individual’s ability

to meet the strength demands of jobs,

and nonexertional limitations or

restrictions affect an individual’s ability

to meet the nonstrength demands of

jobs. Therefore, a symptom in itself is

neither exertional nor nonexertional.

Rather, it is the nature of the functional

limitations or restrictions caused by an