[Federal Register Volume 61, Number 128 (Tuesday, July 2, 1996)]
[Notices]
[Pages 34488-34489]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-16687]


-----------------------------------------------------------------------


SOCIAL SECURITY ADMINISTRATION

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    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 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 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: 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

[[Page 34489]]

impairment-related symptom that determines whether the impact of the 
symptom is exertional, nonexertional, or both.
    4. The application of the medical-vocational 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.<SUP>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,<SUP>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.
---------------------------------------------------------------------------

    \1\ This 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.''
---------------------------------------------------------------------------

    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 age-appropriate 
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 medical-
vocational 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