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
Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34489

1This definition of disability applies to

individuals claiming disability benefits under title

II and individuals age 18 or older claiming

disability benefits under title XVI. For title XVI, an

individual under age 18 will be considered disabled

if he or she is suffering from a medically

determinable physical or mental impairment of

comparable severity to an impairment that would

disable an adult.

2 20 CFR 404.1528, 404.1529, 416.928, and

416.929 provide that symptoms, such as pain,

fatigue, shortness of breath, weakness or

nervousness, are an individual’s own perception or

description of the impact of his or her physical or

mental impairment(s). (20 CFR 416.928 further

provides that, for an individual under age 18 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.)

However, when any of these manifestations is an

anatomical, physiological, or psychological

abnormality that can be shown by medically

acceptable clinical diagnostic techniques, it

represents a medical ‘‘sign’’ rather than a

‘‘symptom.’’

impairment-related symptom that

determines whether the impact of the

symptom is exertional, nonexertional, or

both.

4. The application of the medicalvocational rules in appendix 2 of

subpart P of Regulations No. 4 depends

on the nature of the limitations and

restrictions imposed by an individual’s

medically determinable physical or

mental impairment(s), and any related

symptoms.

Citations (Authority): Sections 216(i),

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

Security Act, as amended; Regulations

No. 4, sections 404.1505, 404.1508,

404.1520, 404.1528(a), 404.1529,

404.1569a and subpart P, appendix 2;

and Regulations No. 16, sections

416.905, 416.908, 416.920, 416.924,

416.928(a), 416.929 and 416.969a.

Policy Interpretation

Need To Establish the Existence of a

Medically Determinable Physical or

Mental Impairment

The Act defines disability as the

inability to do any substantial gainful

activity by reason of any medically

determinable physical or mental

impairment that can be expected to

result in death or which has lasted or

can be expected to last for a continuous

period of not less than 12 months.1 An

‘‘impairment’’ must result from

anatomical, physiological, or

psychological abnormalities that can be

shown by medically acceptable clinical

and laboratory diagnostic techniques.

Although the regulations provide that

the existence of a medically

determinable physical or mental

impairment must be established by

medical evidence consisting of signs,

symptoms,2 and laboratory findings, the

regulations further provide that under

no circumstances may the existence of

an impairment be established on the

basis of symptoms alone. Thus,

regardless of how many symptoms an

individual alleges, or how genuine the

individual’s complaints may appear to

be, the existence of a medically

determinable physical or mental

impairment cannot be established in the

absence of objective medical

abnormalities; i.e., medical signs and

laboratory findings.

No symptom or combination of

symptoms by itself can constitute a

medically determinable impairment. In

claims in which there are no medical

signs or laboratory findings to

substantiate the existence of a medically

determinable physical or mental

impairment, the individual must be

found not disabled at step 2 of the

sequential evaluation process set out in

20 CFR 404.1520 and 416.920 (or, for an

individual under age 18 claiming

disability benefits under title XVI, 20

CFR 416.924).

In addition, 20 CFR 404.1529 and

416.929 provide that an individual’s

symptoms, such as pain, fatigue,

shortness of breath, weakness, or

nervousness, will not be found to affect

the individual’s ability to do basic work

activities (or, for an individual under

age 18 claiming disability benefits under

title XVI, to function independently,

appropriately, and effectively in an ageappropriate manner) unless medical

signs and laboratory findings show that

there is a medically determinable

physical or mental impairment(s) that

could reasonably be expected to

produce the symptom(s) alleged.

Exertional and Nonexertional

Limitations

Once the existence of a medically

determinable physical or mental

impairment(s) that could reasonably be

expected to produce the pain or other

symptoms alleged has been established

on the basis of medical signs and

laboratory findings, allegations about

the intensity and persistence of the

symptoms must be considered with the

objective medical abnormalities, and all

other evidence in the case record, in

evaluating the functionally limiting

effects of the impairment(s). In addition,

for determinations or decisions at step

5 of the sequential evaluation process

for individuals claiming disability

benefits under title II and individuals

age 18 or older claiming disability

benefits under title XVI, 20 CFR

404.1569a and 416.969a explain that an

individual’s impairment(s) and related

symptoms, such as pain, may cause

limitations of function or restrictions

that limit an individual’s ability to meet

certain demands of jobs. These sections

divide limitations or restrictions into

three classifications: Exertional,

nonexertional, and combined exertional

and nonexertional. Exertional

limitations or restrictions affect an

individual’s ability to meet the seven

strength demands of jobs (sitting,

standing, walking, lifting, carrying,

pushing, and pulling), while

nonexertional limitations or restrictions

affect an individual’s ability to meet the

nonstrength demands of jobs (all

physical limitations and restrictions that

are not reflected in the seven strength

demands, and mental limitations and

restrictions). The nature of the

limitations or restrictions affects

whether the rules in appendix 2 to

subpart P of Regulations No. 4 may be

used to direct a decision or must be

used as a framework for

decisionmaking.

Likewise, under the regulations,

symptoms in themselves are neither

exertional nor nonexertional. An

individual’s symptoms, however, can

cause limitations or restrictions that are

classified as exertional, nonexertional,

or a combination of both. For example,

pain can result in an exertional

limitation if it limits the ability to

perform one of the strength activities

(e.g., lifting), or a nonexertional

limitation if it limits the ability to

perform a nonstrength activity (e.g.,

fingering or concentrating). It is the

nature of the limitations or restrictions

resulting from the symptom (i.e.,

exertional, nonexertional, or both) that

will determine whether the medicalvocational rules in appendix 2 may be

used to direct a decision or must be

used as a framework for

decisionmaking. For additional

discussion of this longstanding policy,

see SSR 96–8p, ‘‘Titles II and XVI:

Assessing Residual Functional Capacity

in Initial Claims.’’

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 96–7p, ‘‘Titles II and XVI:

Evaluation of Symptoms in Disability

Claims: Assessing the Credibility of an

Individual’s Statements,’’ and SSR 96–

8p, ‘‘Titles II and XVI: Assessing

Residual Functional Capacity in Initial

Claims;’’ and Program Operations

Manual System, sections DI 24501.020,

DI 24515.061, and DI 24515.063.

[FR Doc. 96–16687 Filed 7–1–96; 8:45 am]

BILLING CODE 4190–29–P