[Federal Register Volume 61, Number 128 (Tuesday, July 2, 1996)]
[Notices]
[Pages 34483-34488]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-16690]


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

SOCIAL SECURITY ADMINISTRATION
[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

[[Page 34484]]

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.<SUP>1 In particular, this Ruling emphasizes that:
---------------------------------------------------------------------------

    \1\ For 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.
---------------------------------------------------------------------------

    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).<SUP>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.
---------------------------------------------------------------------------

    \2\ For 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).
---------------------------------------------------------------------------

    The regulations describe a two-step process for evaluating 
symptoms, such as pain, fatigue, shortness of breath, weakness, or 
nervousness:
    <bullet> 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.<SUP>3 The 
finding that an

[[Page 34485]]

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.
---------------------------------------------------------------------------

    \3\ The 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.
---------------------------------------------------------------------------

    <bullet> 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.<SUP>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.'')
---------------------------------------------------------------------------

    \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).
---------------------------------------------------------------------------

    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

[[Page 34486]]

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:
    <bullet> The medical signs and laboratory findings;
    <bullet> Diagnosis, prognosis, and other medical opinions provided 
by treating or examining physicians or psychologists and other medical 
sources; and
    <bullet> 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,<SUP>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.
---------------------------------------------------------------------------

    \5\ The seven factors are also set out in the ``Introduction,'' 
above.
---------------------------------------------------------------------------

    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:
    <bullet> 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.
    <bullet> 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.
    <bullet> 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

[[Page 34487]]

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:
    <bullet> 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.
    <bullet> A longitudinal record of any treatment and its success or 
failure, including any side effects of medication.
    <bullet> 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.<SUP>6
---------------------------------------------------------------------------

    \6\ The 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.
---------------------------------------------------------------------------

    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:
    <bullet> 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.
    <bullet> The individual's symptoms may not be severe enough to 
prompt the individual to seek ongoing medical attention or may be 
relieved with over-the-counter medications.
    <bullet> The individual may not take prescription medication 
because the side effects are less tolerable than the symptoms.
    <bullet> The individual may be unable to afford treatment and may 
not have access to free or low-cost medical services.
    <bullet> 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.
    <bullet> 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.

[[Page 34488]]

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