34466 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

community ties, age, and combination

of factors.

• Criminal History. Priority issues for

the 1996–97 amendment cycle include:

(1) Re-ordering and streamlining

Chapter Four; and (2) revising

assignment of criminal history points to

better target serious, repeat offenders.

• Sentencing Table. Issues of lower

immediate priority for discussion

during future amendment cycles

include: (1) Options to streamline

sentencing table to reduce significantly

the number of offense levels; (2) options

to revise the current sentencing table’s

‘‘zone’’ structure; and (3) additional or

expanded sentencing options.

• Appellate Litigation and Other

Statutory Issues. Priority issues for the

1996–97 amendment cycle include: (1)

Consideration of the impact of the

recent U.S. Supreme Court decision in

Koon v. United States, supra, on

appellate review of guideline sentences

and on the need to revise the

introduction to the Guidelines Manual

and Departure Section (§ 5K2.0) to

address the deference appellate courts

should afford district courts on

guideline determinations; and (2)

consideration of widening the bands in

monetary and drug tables to decrease

litigation.

• Drug Sentencing/Role in the

Offense. Priority issues for 1996–97

amendment cycle include: (1) Revising

the Role in the Offense guideline to

better reflect actual experience, case law

development, and to provide sufficient

flexibility when sentencing drug

offenders.

• Introduction to Guidelines Manual.

Priority issues for 1996–97 amendment

cycle include: (1) Updating the

introduction to reflect the evolution of

the guideline sentencing process.

III. Circuit Conflicts, Miscellaneous

Amendments

As part of the 1996–97 amendment

cycle, the Commission expects to

consider and propose for comment

amendments that address some of the

more important application issues

involving conflicting court

interpretations of guideline language.

IV. Cocaine Offenses

Under Public Law No. 104–38 (Oct.

30, 1995), the Commission is directed to

submit recommendations to Congress

regarding changes in the penalty

statutes and sentencing guidelines for

cocaine offenses (including crack). See

61 FR 80 (January 2, 1996). The

Commission has been gathering and

analyzing data and other relevant

information, including public comment,

in preparation for formulating the

required recommendations. It expects to

continue this process during the coming

months and again invites comment

regarding implementation of this

congressional directive. Comment

should focus on (1) the quantity ratio

that should be substituted for the

current 100-to-1 ratio in the relevant

penalty statutes and sentencing

guidelines (see USSG § 2D1.1(c)), and

(2) appropriate enhancements in § 2D1.1

for violence and other harms associated

with crack and powder cocaine.

V. Revisions to Money Laundering

Guidelines

As directed by Public Law 104–38,

supra, the Commission will respond to

an expected Department of Justice

report on money laundering charging

and plea practices and will continue its

study of the money laundering

guidelines (U.S.S.G. §§ 2S1.1–2S1.2).

VI. Guideline Assessment, Research

Initiatives

Under the direction of an outside

consultant, Commission staff have

initiated a number of research projects

designed to assess the success of the

guidelines. See 60 FR 49316–17 (Sept.

22, 1995). These efforts will continue in

the coming year, focusing primarily on

the use of an intensive study sample

(ISS) of cases to better evaluate

operation of the Relevant Conduct and

Criminal History guidelines.

V. Administrative Initiatives

As indicated in its 1995 work

priorities notice, see 60 FR 49316, 17

(Sept. 22, 1995), the Commission is

engaged in an ongoing effort to

maximize the efficiency of its limited

staff resources. Additionally, the

Commission expects to soon publish for

comment a set of Rules of Practice and

Procedure describing its internal

operating practices and the manner in

which interested persons can participate

in the Commission’s work.

[FR Doc. 96–16873 Filed 7–1–96; 8:45 am]

BILLING CODE 2210–40–P

SOCIAL SECURITY ADMINISTRATION

Social Security Ruling (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

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 SSR 96–6p. This Ruling

clarifies Social Security Administration

policy regarding the consideration of

findings of fact by State agency medical

and psychological consultants and other

program physicians and psychologists

by adjudicators at the administrative

law judge and Appeals Council levels.

Also, the Ruling restores to the Rulings

and clarifies policy interpretations

regarding administrative law judge and

Appeals Council responsibility for

obtaining opinions of physicians or

psychologists designated by the

Commissioner of Social Security

regarding equivalence to listings in the

Listing of Impairments (appendix 1,

subpart P of 20 CFR part 404) formerly

in SSR 83–19, ‘‘Titles II and XVI:

Finding Disability on the Basis of

Medical Considerations Alone—The

Listing of Impairments and Medical

Equivalency.’’ SSR 83–19 was rescinded

without replacement by SSR 91–7c (C.E.

1990–1991, p. 92) as a result of the

Supreme Court’s decision in Sullivan v.

Zebley, 493 U.S. 521 (1990), which

invalidated the use of a medical

‘‘listings only’’ approach to evaluating

disability claims of individuals under

18 years of age under the supplemental

security income program. That decision

has no bearing on the aspects of SSR

83–19 that we are restoring in this

Ruling.

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
Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34467

1 ‘‘Medical sources’’ are defined in 20 CFR

404.1502 and 416.902 as ‘‘treating sources,’’

‘‘sources of record’’ (i.e., medical sources that have

provided an individual with medical treatment or

evaluation, but do not have or did not have an

ongoing treatment relationship with the individual),

and ‘‘consultative examiners’’ for the Social

Security Administration.

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: 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

Purpose: To clarify Social Security

Administration policy regarding the

consideration of findings of fact by State

agency medical and psychological

consultants and other program

physicians and psychologists by

adjudicators at the administrative law

judge and Appeals Council levels. Also,

to restore to the Rulings and clarify

policy interpretations regarding

administrative law judge and Appeals

Council responsibility for obtaining

opinions of physicians or psychologists

designated by the Commissioner

regarding equivalence to listings in the

Listing of Impairments (appendix 1,

subpart P of 20 CFR part 404) formerly

in SSR 83–19. In particular, to

emphasize the following longstanding

policies and policy interpretations:

1. Findings of fact made by State

agency medical and psychological

consultants and other program

physicians and psychologists regarding

the nature and severity of an

individual’s impairment(s) must be

treated as expert opinion evidence of

nonexamining sources at the

administrative law judge and Appeals

Council levels of administrative review.

2. Administrative law judges and the

Appeals Council may not ignore these

opinions and must explain the weight

given to these opinions in their

decisions.

3. An updated medical expert opinion

must be obtained by the administrative

law judge or the Appeals Council before

a decision of disability based on

medical equivalence can be made.

Citations (Authority): Sections 216(i),

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

Security Act (the Act), as amended;

Regulations No. 4, sections 404.1502,

404.1512(b)(6), 404.1526, 404.1527, and

404.1546; and Regulations No. 16,

sections 416.902, 416.912(b)(6), 416.926,

416.927, and 416.946.

Introduction: Regulations 20 CFR

404.1527 and 416.927 set forth detailed

rules for evaluating medical opinions

about an individual’s impairment(s)

offered by medical sources 1 and the

medical opinions of State agency

medical and psychological consultants

and other nonexamining sources.

Paragraph (a) of these regulations

provides that ‘‘medical opinions’’ are

statements from physicians and

psychologists or other acceptable

medical sources that reflect judgments

about the nature and severity of an

individual’s impairment(s), including

symptoms, diagnosis and prognosis,

what the individual can still do despite

his or her impairment(s), and the

individual’s physical or mental

restrictions. Paragraph (b) provides that,

in deciding whether an individual is

disabled, the adjudicator will always

consider the medical opinions in the

case record together with the rest of the

relevant evidence. Paragraphs (c), (d),

and (e) then provide general rules for

evaluating the record, with particular

attention to medical and other opinions

from acceptable medical sources.

Paragraph (f) provides that findings of

fact made by State agency medical and

psychological consultants and other

program physicians and psychologists

become opinions at the administrative

law judge and Appeals Council levels of

administrative review and requires

administrative law judges and the

Appeals Council to consider and

evaluate these opinions when making a

decision in a particular case.

State agency medical and

psychological consultants are highly

qualified physicians and psychologists

who are experts in the evaluation of the

medical issues in disability claims

under the Act. As members of the teams

that make determinations of disability at

the initial and reconsideration levels of

the administrative review process

(except in disability hearings), they

consider the medical evidence in

disability cases and make findings of

fact on the medical issues, including,

but not limited to, the existence and

severity of an individual’s

impairment(s), the existence and

severity of an individual’s symptoms,

whether the individual’s impairment(s)

meets or is equivalent in severity to the

requirements for any impairment listed

in 20 CFR part 404, subpart P, appendix

1 (the Listing of Impairments), and the

individual’s residual functional capacity

(RFC).

Policy Interpretation: Because State

agency medical and psychological

consultants and other program

physicians and psychologists are

experts in the Social Security disability

programs, the rules in 20 CFR

404.1527(f) and 416.927(f) require

administrative law judges and the

Appeals Council to consider their

findings of fact about the nature and

severity of an individual’s

impairment(s) as opinions of

nonexamining physicians and

psychologists. Administrative law

judges and the Appeals Council are not

bound by findings made by State agency

or other program physicians and

psychologists, but they may not ignore

these opinions and must explain the

weight given to the opinions in their

decisions.

Paragraphs 404.1527(f) and 416.927(f)

provide that the rules for considering

medical and other opinions of treating

sources and other sources in paragraphs

(a) through (e) also apply when we

consider the medical opinions of

nonexamining sources, including State

agency medical and psychological

consultants and other program

physicians and psychologists. The

regulations provide progressively more

rigorous tests for weighing opinions as

the ties between the source of the

opinion and the individual become

weaker. For example, the opinions of

physicians or psychologists who do not

have a treatment relationship with the

individual are weighed by stricter

standards, based to a greater degree on

medical evidence, qualifications, and

explanations for the opinions, than are

required of treating sources.

For this reason, the opinions of State

agency medical and psychological

consultants and other program

physicians and psychologists can be

given weight only insofar as they are

supported by evidence in the case

record, considering such factors as the

supportability of the opinion in the

evidence including any evidence

received at the administrative law judge

and Appeals Council levels that was not

before the State agency, the consistency

of the opinion with the record as a
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.