34468 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

2The term ‘‘medical expert’’ is being used to refer

to the source of expert medical opinion designated

as a ‘‘medical advisor’’ in 20 CFR 404.1512(b)(6),

404.1527(f), 416.912(b)(6), and 416.927(f). This term

is being used because it describes the role of the

‘‘medical expert’’ as an expert witness rather than

an advisor in the course of an administrative law

judge hearing.

whole, including other medical

opinions, and any explanation for the

opinion provided by the State agency

medical or psychological consultant or

other program physician or

psychologist. The adjudicator must also

consider all other factors that could

have a bearing on the weight to which

an opinion is entitled, including any

specialization of the State agency

medical or psychological consultant.

In appropriate circumstances,

opinions from State agency medical and

psychological consultants and other

program physicians and psychologists

may be entitled to greater weight than

the opinions of treating or examining

sources. For example, the opinion of a

State agency medical or psychological

consultant or other program physician

or psychologist may be entitled to

greater weight than a treating source’s

medical opinion if the State agency

medical or phychological consultant’s

opinion is based on a review of a

complete case record that includes a

medical report from a specialist in the

individual’s particular impairment

which provides more detailed and

comprehensive information than what

was available to the individual’s treating

source.

The following additional guidelines

apply at the administrative law judge

and Appeals Council levels to opinions

about equivalence to a listing in the

Listing of Impairments and RFC

assessments, issues that are reserved to

the Commissioner in 20 CFR

404.1527(e) and 416.927(e). (See also

SSR 96–5p, ‘‘Titles II and XVI: Medical

Source Opinions on Issues Reserved to

the Commissioner.’’)

Medical Equivalence to an Impairment

in the Listing of Impairments.

The administrative law judge or

Appeals Council is responsible for

deciding the ultimate legal question

whether a listing is met or equaled. As

trier of the facts, an administrative law

judge or the Appeals Council is not

bound by a finding by a State agency

medical or psychological consultant or

other program physician or psychologist

as to whether an individual’s

impairment(s) is equivalent in severity

to any impairment in the Listing of

Impairments. However, longstanding

policy requires that the judgment of a

physician (or psychologist) designated

by the Commissioner on the issue of

equivalence on the evidence before the

administrative law judge or the Appeals

Council must be received into the

record as expert opinion evidence and

given appropriate weight.

The signature of a State agency

medical or psychological consultant on

an SSA–831–U5 (Disability

Determination and Transmittal Form) or

SSA–832–U5 or SSA–833–U5

(Cessation or Continuance of Disability

or Blindness) ensures that consideration

by a physician (or psychologist)

designated by the Commissioner has

been given to the question of medical

equivalence at the initial and

reconsideration levels of administrative

review. Other documents, including the

Psychiatric Review Technique Form and

various other documents on which

medical and psychological consultants

may record their findings, may also

ensure that this opinion has been

obtained at the first two levels of

administrative review.

When an administrative law judge or

the Appeals Council finds that an

individual’s impairment(s) is not

equivalent in severity to any listing, the

requirement to receive expert opinion

evidence into the record may be

satisfied by any of the foregoing

documents signed by a State agency

medical or psychological consultant.

However, an administrative law judge

and the Appeals Council must obtain an

updated medical opinion from a

medical expert 2 in the following

circumstances:

• When no additional medical

evidence is received, but in the opinion

of the administrative law judge or the

Appeals Council the symptoms, signs,

and laboratory findings reported in the

case record suggest that a judgment of

equivalence may be reasonable; or

When additional medical evidence is

received that in the opinion of the

administrative law judge or the Appeals

Council may change the State agency

medical or psychological consultant’s

finding that the impairment(s) is not

equivalent in severity to any

impairment in the Listing of

Impairments.

When an updated medical judgment

as to medical equivalence is required at

the administrative law judge level in

either of the circumstances above, the

administrative law judge must call on a

medical expert. When an updated

medical judgment as to medical

equivalence is required at the Appeals

Council level in either of the

circumstances above, the Appeals

Council must call on the services of its

medical support staff.

Assessment of RFC

Although the administrative law

judge and the Appeals Council are

responsible for assessing an individual’s

RFC at their respective levels of

administrative review, the

administrative law judge or Appeals

Council must consider and evaluate any

assessment of the individual’s RFC by a

State agency medical or psychological

consultant and by other program

physicians or psychologists. At the

administrative law judge and Appeals

Council levels, RFC assessments by

State agency medical or psychological

consultants or other program physicians

or psychologists are to be considered

and addressed in the decision as

medical opinions from nonexamining

sources about what the individual can

still do despite his or her impairment(s).

Again, they are to be evaluated

considering all of the factors set out in

the regulations for considering opinion

evidence.

Effective Date: This Ruling is effective

on the date of its publication in the

Federal Register.

Cross-References: SSR 96–5p, ‘‘Titles

II and XVI: Medical Source Opinions on

Issues Reserved to the Commissioner;’’

Program Operations Manual System,

section DI 24515.007; and Hearings,

Appeals, and Litigation Law Manual,

section I–5–310.

[FR Doc. 96–16689 Filed 7–1–96; 8:45 am]

BILLING CODE 4190–29–P

Social Security Ruling (SSR) 96–3p.

Titles II and XVI: Considering

Allegations of Pain and Other

Symptoms in Determining Whether a

Medically Determinable Impairment Is

Severe

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 96–3p. This Ruling

restates and clarifies the longstanding

policies of the Social Security

Administration for considering

allegations of pain or other symptoms in

determining whether individuals

claiming 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 have a ‘‘severe’’

medically determinable physical or

mental impairment(s).

EFFECTIVE DATE: July 2, 1996.
Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34469

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: Considering Allegations of

Pain and Other Symptoms in

Determining Whether a Medically

Determinable Impairment is Severe

Purpose

To restate and clarify the longstanding

policies of the Social Security

Administration for considering

allegations of pain or other symptoms in

determining whether individuals

claiming disability benefits under title II

and title XVI of the Social Security Act

(the Act) have a ‘‘severe’’ medically

determinable physical or mental

impairment(s). In particular, the

purpose of this Ruling is to restate and

clarify the policy that:

1. The evaluation of whether an

impairment(s) is ‘‘severe’’ that is done at

step 2 of the applicable sequential

evaluation process set out in 20 CFR

404.1520, 416.920, or 416.924 requires

an assessment of the functionally

limiting effects of an impairment(s) on

an individual’s ability to do basic work

activities or, for an individual under age

18 claiming disability benefits under

title XVI, to do age-appropriate

activities; and

2. An individual’s symptoms may

cause limitations and restrictions in

functioning which, when considered at

step 2, may require a finding that there

is a ‘‘severe’’ impairment(s) and a

decision to proceed to the next step of

sequential evaluation.

Citations (Authority): Sections 216(i),

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

Act, as amended; Regulations No. 4, sections

404.1508, 404.1520(a) and (c), 404.1521,

404.1523, 404.1528, and 404.1529; and

Regulations No. 16, sections 416.908,

416.920(a) and (c), 416.921, 416.923,

416.924(b) and (d), 416.924d, 416.928, and

416.929.

Introduction

Note: For clarity, the following

discussions 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 principles

regarding the evaluation of symptoms

and their effects apply in determining

whether the impairment(s) of an

individual who is under age 18 and

claiming title XVI disability benefits is

severe under 20 CFR 416.924(d). For

such an individual, an impairment(s) is

considered ‘‘not severe’’ if it is a slight

abnormality(ies) that causes no more

than minimal limitation in the

individual’s ability to function

independently, appropriately, and

effectively in an age-appropriate

manner.

To be found disabled, an individual

must have a medically determinable

‘‘severe’’ physical or mental impairment

or combination of impairments that

meets the duration requirement. At step

2 of the sequential evaluation process,

an impairment or combination of

impairments is considered ‘‘severe’’ if it

significantly limits an individual’s

physical or mental abilities to do basic

work activities; an impairment(s) that is

‘‘not severe’’ must be a slight

abnormality (or a combination of slight

abnormalities) that has no more than a

minimal effect on the ability to do basic

work activities. (See SSR 85–28, ‘‘Titles

II and XVI: Medical Impairments That

Are Not Severe,’’ C.E. 1981–1985, p.

394.)

Symptoms, such as pain, fatigue,

shortness of breath, weakness, or

nervousness, will not be found to affect

an individual’s ability to do basic work

activities unless the individual first

establishes by objective medical

evidence (i.e., signs and laboratory

findings) that he or she has a medically

determinable physical or mental

impairment(s) and that the

impairment(s) could reasonably be

expected to produce the alleged

symptom(s). (See SSR 96–4p, ‘‘Titles II

and XVI: Symptoms, Medically

Determinable Physical and Mental

Impairments, and Exertional and

Nonexertional Limitations.’’) The

finding that an individual’s

impairment(s) could reasonably be

expected to produce the alleged

symptom(s) does not involve a

determination as to the intensity,

persistence, or functionally limiting

effects of the symptom(s). However,

once the requisite relationship between

the medically determinable

impairment(s) and the alleged

symptom(s) is established, the intensity,

persistence, and limiting effects of the

symptom(s) must be considered along

with the objective medical and other

evidence in determining whether the

impairment or combination of

impairments is severe.

Policy Interpretation

In determining the severity of an

impairment(s) at step 2 of the sequential

evaluation process set out in 20 CFR

404.1520 and 416.920, evidence about

the functionally limiting effects of an

individual’s impairment(s) must be

evaluated in order to assess the effect of

the impairment(s) on the individual’s

ability to do basic work activities. The

vocational factors of age, education, and

work experience are not considered at

this step of the process. A determination

that an individual’s impairment(s) is not

severe requires a careful evaluation of

the medical findings that describe the

impairment(s) (i.e., the objective

medical evidence and any impairmentrelated symptoms), and an informed

judgment about the limitations and

restrictions the impairment(s) and

related symptom(s) impose on the

individual’s physical and mental ability

to do basic work activities. (See SSR 96–

7p, ‘‘Titles II and XVI: Evaluation of

Symptoms in Disability Claims:

Assessing the Credibility of an

Individual’s Statements.’’)

Because a determination whether an

impairment(s) is severe requires an

assessment of the functionally limiting

effects of an impairment(s), symptomrelated limitations and restrictions must

be considered at this step of the

sequential evaluation process, provided

that the individual has a medically
34470 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

determinable impairment(s) that could

reasonably be expected to produce the

symptoms. If the adjudicator finds that

such symptoms cause a limitation or

restriction having more than a minimal

effect on an individual’s ability to do

basic work activities, the adjudicator

must find that the impairment(s) is

severe and proceed to the next step in

the process even if the objective medical

evidence would not in itself establish

that the impairment(s) is severe. In

addition, if, after completing

development and considering all of the

evidence, the adjudicator is unable to

determine clearly the effect of an

impairment(s) on the individual’s

ability to do basic work activities, the

adjudicator must continue to follow the

sequential evaluation process until a

determination or decision about

disability can be reached.

Effective Date

This Ruling is effective on July 2,

1996.

Cross-References

SSR 85–28, ‘‘Titles II and XVI:

Medical Impairments That are Not

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

Symptoms, Medically Determinable

Physical and Mental Impairments, and

Exertional and Nonexertional

Limitations,’’ and SSR 96–7p, ‘‘Titles II

and XVI: Evaluation of Symptoms in

Disability Claims: Assessing the

Credibility of an Individual’s

Statements;’’ and Program Operations

Manual System, sections DI 24505.001,

DI 24505.005, DI 24515.061, DI

25215.005, DI 25225.001, DI 26515.005,

DI 26515.015, and DI 26516.010.

[FR Doc. 96–16686 Filed 7–1–96; 8:45 am]

BILLING CODE 4190–29–P

[Social Security Ruling (SSR) 96–1p]

Application by the Social Security

Administration (SSA) of Federal Circuit

Court and District Court Decisions

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 96–1p. This Ruling

clarifies SSA’s longstanding policies

that (1) unless and until a Social

Security Acquiescence Ruling is issued

determining that a final circuit court

holding conflicts with the Agency’s

interpretation of the Social Security Act

or regulations and explaining how SSA

will apply such a holding, SSA

decisionmakers will continue to be

bound by SSA’s nationwide policy,

rather than the court’s holding, in

adjudicating other claims within that

circuit court’s jurisdiction, and (2)

despite a district court decision which

may conflict with SSA’s interpretation

of the Social Security Act or regulations,

SSA adjudicators will continue to apply

SSA’s nationwide policy when

adjudicating other claims within that

district court’s jurisdiction unless the

court directs otherwise.

This Ruling does not in any way

modify SSA’s acquiescence policy to

which the Agency continues to remain

firmly committed, but instead serves to

emphasize consistent adjudication in

the programs SSA administers.

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

Application by the Social Security

Administration (SSA) of Federal Circuit

Court and District Court Decisions

Purpose: To clarify longstanding

policy that, unless and until a Social

Security Acquiescence Ruling (AR) is

issued determining that a final circuit

court holding conflicts with the

Agency’s interpretation of the Social

Security Act or regulations and

explaining how SSA will apply such a

holding, SSA decisionmakers continue

to be bound by SSA’s nationwide

policy, rather than the court’s holding,

in adjudicating other claims within that

circuit court’s jurisdiction. This Ruling

does not in any way modify SSA’s

acquiescence policy to which the

Agency continues to remain firmly

committed, but instead serves to

emphasize consistent adjudication in

the programs SSA administers. This

Ruling is also issued to clarify

longstanding Agency policy that,

despite a district court decision which

may conflict with SSA’s interpretation

of the Social Security Act or regulations,

SSA adjudicators will continue to apply

SSA’s nationwide policy when

adjudicating other claims within that

district court’s jurisdiction unless the

court directs otherwise.

Citations (Authority): Sections 205(a),

702(a)(5) and 1631(d) of the Social

Security Act; Sections 413(b), 426(a)

and 508 of the Black Lung Benefits Act;

Regulations No. 4, section 404.985;

Regulations No. 10, section 410.670c;

Regulations No. 16, section 416.1485;

Regulations No. 22, section 422.406.

Background: Final regulations on the

application of circuit court law in the

Social Security, Supplemental Security

Income, and Black Lung programs were

published in the Federal Register on

January 11, 1990 (55 FR 1012). SSA first

adopted the acquiescence policy set

forth in these rules in 1985, with the

details evolving over the next 5 years.

These rules explain how SSA

acquiesces in circuit court law which

conflicts with Agency policy; it does so

by issuing an AR for a final circuit court

decision which SSA determines is in

conflict with the Agency’s interpretation

of the Social Security Act or regulations.

20 CFR 404.985(b), 410.670c(b) and

416.1485(b). The AR, which is issued

through publication in the Federal

Register, describes the administrative

case and the court decision, identifies

the issue(s), explains how the court

decision differs from SSA policy, and