[Federal Register Volume 60, Number 175 (Monday, September 11, 1995)]
[Proposed Rules]
[Pages 47121-47126]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-22103]
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RAILROAD RETIREMENT BOARD
20 CFR Part 220
RIN 3220-AA99
Determining Disability
AGENCY: Railroad Retirement Board.
ACTION: Proposed rule.
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SUMMARY: The Board proposes to update its regulations to reflect a
change in how it evaluates pain and other subjective symptoms when
determining if an individual is disabled from all regular employment.
Other changes are proposed to reflect changes in law and procedure.
DATES: Comments must be received by November 13, 1995.
ADDRESSES: Secretary to the Board, Railroad Retirement Board, 844 North
Rush Street, Chicago, Illinois 60611-2092.
FOR FURTHER INFORMATION CONTACT: Thomas W. Sadler, Assistant General
Counsel, Railroad Retirement Board, 844 North Rush Street, Chicago,
Illinois 60611, (312) 751-4513, TDD (312) 751-4701.
SUPPLEMENTARY INFORMATION: Courts have consistently held that
disability for all regular employment under section 2(a)(1)(v) of the
Railroad Retirement Act (45 U.S.C. 231a(a)(1)(v)) is synonymous with
the inability to perform any substantial gainful activity under section
223(d) of the Social Security Act (42 U.S.C. 423(d)). Therefore, the
Board has generally patterned its regulations dealing with the
adjudication of claims for disability based upon the inability to
engage in all regular employment (20 CFR Part 220) on regulations
promulgated by the Department of Health and Human Services, Social
Security Administration (20 CFR Part 404, Subpart P). On November 14,
1991, the Social Security Administration published a final rule (56 FR
57928) expanding its regulations pertaining to how it evaluates
symptoms, including pain, in its disability adjudication. The Board has
generally followed these regulations in adjudication of claims for
disability based on inability to engage in regular employment and now
proposes to amend its regulations to conform thereto.
Proposed Sec. 220.100(f) explains how a symptom, such as pain, is
considered when it appears as a criterion in the Listing of Impairments
contained in Appendix 1 of this part. Appendix 1 contains medical
criteria for finding a person disabled on medical factors alone without
consideration of the person's age, education, and work experience.
The addition of proposed Sec. 220.100(g) insures that the Listing
of Impairments contained in Appendix 1 will at all times conform to
Appendix 1 of Subpart P, 20 CFR, Part 404, of the Social Security
Adminitration's disability regulations unless specifically indicated
otherwise by regulation under this part.
Section 220.112(a) is proposed to be revised by eliminating the
reference to remarried widow(ers) and surviving divorced spouses.
Section 5103 of Public Law 101-508 revised the standard of disability
for these groups of beneficiaries to require the consideration of other
than medical factors, such as age, education, and experience, in
determining disability for all substantial gainful activity for these
groups. Prior to the amendment, only medical factors were required to
be used in a disability determination for these beneficiaries.
The proposed rule completely revises Sec. 220.114 to parallel the
Social Security regulation dealing with the same subject. See
Sec. 404.1529 of this chapter. Proposed Sec. 220.114 will provide
guidance on the evaluation of symptoms, including pain. The proposed
regulation conforms to the Board's current procedures and applicable
court decisions on the evaluation of symptoms, especially pain, in
making disability determinations.
Paragraph (a) of proposed Sec. 220.114 is a general statement of
how symptoms, such as pain, are considered in determining disability.
It explains that the Board will consider a claimant's symptoms along
with other objective medical evidence and other evidence relating to a
claimant's condition.
Paragraph (b) of proposed Sec. 220.114 explains that the Board will
not find that pain will affect an individual's ability to do basic work
activities unless the claimant first establishes that he or she has a
medically determinable physical or mental impairment, supported by
medical signs and laboratory findings, to which the allegation of pain
can reasonably be related.
Paragraph (c) of proposed Sec. 220.114 provides that when a
symptom, such as pain, is established, the Board must then evaluate the
intensity and persistence of the symptom with respect to how it limits
the claimant's capacity for work. In making this evaluation the Board
considers all available evidence, including the claimant's medical
history, statements from the claimant and his treating physician, and
statements from others who have knowledge of the claimant's situation.
Paragraph (d) of proposed Sec. 220.114 explains how symptoms, such
as pain, are evaluated in the sequential evaluation process required in
disability adjudication.
The proposed rule would revise Sec. 220.120 to explain that in
determining the claimant's residual functional capacity the Board
considers the claimant's symptoms, such as pain, and that such pain or
other symptoms may limit the claimant's residual functional capacity
beyond what can be determined from anatomical or physiological
abnormalities taken alone. Consistent with the revision of section
220.120, proposed new Sec. 220.135 explains that a claimant's symptoms,
such as pain, may cause both exertional and nonexertional limitations.
This proposed new section defines these terms. Only when the claimant's
impairments and related symptoms impose solely exertional impairments
do the rules set forth in Appendix 2 of this part direct a conclusion.
Proposed Sec. 220.134 does for Appendix 2 of this part what the
proposed amendment to Sec. 220.100(g) does for Appendix 1 and insures
that Appendix 2 will be consistent with the comparable appendix in the
regulations under the Social Security Act. Appendix 2 contains the
medical vocational guidelines or ``grids''. The grids direct a finding
of disabled or not disabled based on specified limitations combined
with the individual's age, education, and work experience. Appendix 2
was developed by the Social Security Administration after an extensive
administrative rule-making procedure. The Board has adopted the
Administration's Appendix 2 in its disability adjudication. This
amendment will insure that the Board's Appendix 2 automatically remains
in conformance with that of the Social Security Administration except
where otherwise stated by this regulation.
Finally, the proposed amendment to Sec. 200.00 of Appendix 2
conforms that section to the revised Sec. 220.120.
The Board, with the agreement of the Office of Management and
Budget, has determined that this is not a significant regulatory action
under Executive Order 12866; therefore, no regulatory impact analysis
is required. There are no information collections associated with this
rule.
List of Subjects in 20 CFR Part 220
Disability benefits, Railroad employees, Railroad retirement.
For the reasons set out in the preamble, Part 220 of Title 20 of
the
[[Page 47123]]
Code of Federal Regulations is proposed to be amended as follows:
PART 220--DETERMINING DISABILITY
1. The authority for Part 220 continues to read as follows:
Authority: 45 U.S.C. 231a; 45 U.S.C. 231f.
2. Section 220.110 is amended by adding paragraphs (f) and (g) to
read as follows:
Sec. 220.110 Listing of impairments in Appendix 1 of this part.
* * * * *
(f) Symptoms as criteria of listed impairment(s). Some listed
impairment(s) include symptoms usually associated with those
impairment(s) as criteria. Generally, when a symptom is one of the
criteria in a listed impairment, it is only necessary that the symptom
be present in combination with the other criteria. It is not necessary,
unless the listing specifically states otherwise, to provide
information about the intensity, persistence or limiting effects of the
symptom as long as all other findings required by the specific listing
are present.
(g) The Listing of Impairments found in Appendix 1 of this part is
intended to be identical to the list promulgated by the Social Security
Administration in Appendix 1 of Subpart P, 20 CFR Part 404. In addition
to Appendix 1 of this part a claimant should also consult Appendix 1 of
20 CFR, Subpart P, Part 404.
Sec. 220.112 [Amended]
3. The penultimate sentence of Sec. 220.112(a) is amended by
removing the words ``Except in cases of remarried widows, widowers, and
surviving divorced spouses, the'' and adding the word ``The'' to begin
that sentence.
Sec. 220.114 [Amended]
4. Section 220.114 is revised to read as follows:
Sec. 220.114 Evaluation of symptoms, including pain.
(a) General. In determining whether the claimant is disabled, the
Board considers all of the claimant's symptoms, including pain, and the
extent to which the claimant's symptoms can reasonably be accepted as
consistent with the objective medical evidence and other evidence. By
objective medical evidence, the Board means medical signs and
laboratory findings as defined in Sec. 220.113 (b) and (c) of this
part. By other evidence, the Board means the kinds of evidence
described in Secs. 220.45 and 220.46 of this part. These include
statements or reports from the claimant, the claimant's treating or
examining physician or psychologist, and others about the claimant's
medical history, diagnosis, prescribed treatment, daily activities,
efforts to work, and any other evidence showing how the claimant's
impairment(s) and any related symptoms affect the claimant's ability to
work. The Board will consider all of the claimant's statements about
his or her symptoms, such as pain, and any description by the claimant,
the claimant's physician or psychologist, or other persons about how
the symptoms affect the claimant's activities of daily living and
ability to work. However, statements about the claimant's pain or other
symptoms will not alone establish that the claimant is disabled; there
must be medical signs and laboratory findings which show that the
claimant has a medical impairment(s) which could reasonably be expected
to produce the pain or other symptoms alleged and which, when
considered with all of the other evidence (including statements about
the intensity and persistence of the claimant's pain or other symptoms
which may reasonably be accepted as consistent with the medical signs
and laboratory findings), would lead to a conclusion that the claimant
is disabled. In evaluating the intensity and persistence of the
claimant's symptoms, including pain, the Board will consider all of the
available evidence, including the claimant's medical history, the
medical signs and laboratory findings and statements about how the
claimant's symptoms affect the claimant. (Section 220.112 of this part
explains how the Board considers opinions of the claimant's treating
source and other medical opinions on the existence and severity of the
claimant's symptoms, such as pain.) The Board will then determine the
extent to which the claimant's alleged functional limitations and
restrictions due to pain or other symptoms can reasonably be accepted
as consistent with the medical signs and laboratory findings and other
evidence to decide how the claimant's symptoms affect the claimant's
ability to work.
(b) Need for medically determinable impairment that could
reasonably be expected to produce symptoms, such as pain. The
claimant's symptoms, such as pain, fatigue, shortness of breath,
weakness, or nervousness will not be found to affect the claimant's
ability to do basic work activities unless medical signs or laboratory
findings show that a medically determinable impairment(s) is present.
Medical signs and laboratory findings, established by medically
acceptable clinical or laboratory diagnostic techniques, must show the
existence of a medical impairment(s) which results from anatomical,
physiological, or psychological abnormalities and which could
reasonably be expected to produce the pain or other symptoms alleged.
The finding that the claimant's impairment(s) could reasonably be
expected to produce the claimant's pain or other symptoms does not
involve a determination as to the intensity, persistence, or
functionally limiting effects of the claimant's symptoms. The Board
will develop evidence regarding the possibility of a medically
determinable mental impairment when the Board has information to
suggest that such an impairment exists, and the claimant 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.
(c) Evaluating the intensity and persistence of symptoms, such as
pain, and determining the extent to which the claimant's symptoms limit
his or her capacity for work. (1) General. When the medical signs or
laboratory findings show that the claimant has a medically determinable
impairment(s) that could reasonably be expected to produce the
claimant's symptoms, such as pain, the Board must then evaluate the
intensity and persistence of the claimant's symptoms so that it can
determine how the claimant's symptoms limit the claimant's capacity for
work. In evaluating the intensity and persistence of the claimant's
symptoms the Board considers all of the available evidence including
the claimant's medical history, the medical signs and laboratory
findings, and statements from the claimant, the claimant's treating or
examining physician or psychologist, or other persons about how the
claimant's symptoms affect the claimant. The Board also considers the
medical opinions of the claimant's treating source and other medical
opinions as explained in Sec. 220.112 of this part. Paragraphs (c)(2)
through (c)(4) of this section explain further how the Board evaluates
the intensity and persistence of the claimant's symptoms and how it
determines the extent to which the claimant's symptoms limit the
claimant's capacity for work, when the medical signs or laboratory
findings show the claimant has a medically determinable impairment(s)
that could reasonably be expected to produce the claimant's symptoms,
such as pain.
(2) Consideration of objective medical evidence. Objective medical
evidence is evidence obtained from the application
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of medically acceptable clinical and laboratory diagnostic techniques,
such as evidence of reduced joint motion, muscle spasm, sensory deficit
or motor disruption. Objective medical evidence of this type is a
useful indicator to assist the Board in making reasonable conclusions
about the intensity and persistence of the claimant's symptoms and the
effect those symptoms, such as pain, may have on the claimant's ability
to work. The Board must always attempt to obtain objective medical
evidence and, when it is obtained, will consider it in reaching a
conclusion as to whether the claimant is disabled. However, the Board
will not reject the claimant's statements about the intensity and
persistence of the claimant's pain or other symptoms or about the
effect the claimant's symptoms have on the claimant's ability to work
solely because the available objective medical evidence does not
substantiate the claimant's statements.
(3) Consideration of other evidence. Since symptoms sometimes
suggest a greater severity of impairment than can be shown by objective
medical evidence alone, the Board will carefully consider any other
information the claimant may submit about his or her symptoms. The
information that the claimant, the claimant's treating physician or
psychologist, or other persons provide about the claimant's pain or
other symptoms (e.g., what may precipitate or aggravate the claimant's
symptoms, what medications, treatments or other methods he or she uses
to alleviate them, and how the symptoms may affect his or her pattern
of daily living) is also an important indicator of the intensity and
persistence of the claimant's symptoms. Because symptoms, such as pain,
are subjective and difficult to quantify, any symptom-related
functional limitations and restrictions which the claimant, the
claimant's treating or examining physician or psychologist, or other
persons report, which can reasonably be accepted as consistent with the
objective medical evidence and other evidence, will be taken into
account as explained in paragraph (c)(4) of this section in reaching a
conclusion as to whether the claimant is disabled. The Board will
consider all of the evidence presented, including information about the
claimant's prior work record, the claimant's statements about his or
her symptoms, evidence submitted by the claimant's treating, examining
or consulting physician or psychologist, and observations by Board
employees and other persons. Section 220.112 of this part explains in
detail how the Board considers and weighs treating source and other
medical opinions about the nature and severity of the claimant's
impairment(s) and any related symptoms, such as pain. Factors relevant
to the claimant's symptoms, such as pain, which the Board will consider
include:
(i) The claimant's daily activities;
(ii) The location, duration, frequency, and intensity of pain or
other symptoms;
(iii) Precipitating and aggravating factors;
(iv) The type, dosage, effectiveness, and side effects of any
medication the claimant takes or has taken to alleviate pain or other
symptoms;
(v) Treatment, other than medication, the claimant receives or has
received for relief of pain or other symptoms:
(vi) Any measures the claimant uses or has used to relieve pain or
other symptoms (e.g., lying flat on the claimant's back, standing for
15 to 20 minutes every hour, sleeping on a board, etc.); and
(vii) Other factors concerning the claimant's functional
limitations and restrictions due to pain or other symptoms.
(4) How the Board determines the extent to which symptoms, such as
pain, affect the claimant's capacity to perform basic work activities.
In determining the extent to which the claimant's symptoms, such as
pain, affect the claimant's capacity to perform basic work activities,
the Board considers all of the available evidence described in
paragraphs (c)(1) through (c)(3) of this section. The Board will
consider the claimant's statements about the intensity, persistence,
and limiting effects of the claimant's symptoms, and the Board will
evaluate the claimant's statements in relation to the objective medical
evidence and other evidence, in reaching a conclusion as to whether the
claimant is disabled. The Board will consider whether there are any
inconsistencies in the evidence and the extent to which there are any
conflicts between the claimant's statements and the rest of the
evidence, including the claimant's medical history, the medical signs
and laboratory findings and statements by the claimant's treating or
examining physician or psychologist or other persons about how the
claimant's symptoms affect the claimant. The claimant's symptoms,
including pain, will be determined to diminish the claimant's capacity
for basic work activities to the extent that the claimant's alleged
functional limitations and restrictions due to symptoms, such as pain,
can reasonably be accepted as consistent with the objective medical
evidence and other evidence.
(d) Consideration of symptoms in the disability determination
process. The Board follows a set order of steps to determine whether
the claimant is disabled. If the claimant is not doing substantial
gainful activity, the Board considers the claimant's symptoms, such as
pain, to evaluate whether the claimant has a severe physical or mental
impairment(s), and at each of the remaining steps in the process.
Sections 220.100 and 220.101 of this part explain this process in
detail. The Board also considers the claimant's symptoms, such as pain,
at the appropriate steps in the Board's review when the Board considers
whether the claimant's disability continues. Subpart O of this part
explains the procedure the Board follows in reviewing whether the
claimant's disability continues.
(1) Need to establish a severe medically determinable
impairment(s). The claimant's symptoms, such as pain, fatigue,
shortness of breath, weakness, or nervousness, are considered in making
a determination as to whether the claimant's impairment or combination
of impairment(s) is severe. (See Sec. 220.100(b)(2) of this part.)
(2) Decision whether the Listing of Impairments is met. Some listed
impairment(s) include symptoms, such as pain, as criteria. Section
220.110(f) of this part explains how the Board considers the claimant's
symptoms when the claimant's symptoms are included as criteria for a
listed impairment.
(3) Decision whether the Listing of Impairments is equaled. If the
claimant's impairment is not the same as a listed impairment, the Board
must determine whether the claimant's impairment(s) is medically
equivalent to a listed impairment. Section 220.111 of this part
explains how the Board makes this determination. Under Sec. 220.111(b)
of this part, the Board will consider equivalence based on medical
evidence only. In considering whether the claimant's symptoms, signs,
and laboratory findings are medically equal to the symptoms, signs, and
laboratory findings of a listed impairment, the Board will look to see
whether the claimant's symptoms, signs, and laboratory findings are at
least equal in severity to the listed criteria. However, the Board will
not substitute the claimant's allegations of pain or other symptoms for
a missing or deficient sign or laboratory finding to raise the severity
of the claimant's impairment(s) to that of a listed impairment. If the
symptoms, signs, and laboratory findings of the claimant's
impairment(s)
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are equivalent in severity to those of a listed impairment, the Board
will find the claimant disabled. If the Board determines the claimant's
impairment(s) is not medically equivalent to a listed impairment, the
Board will consider the impact of the claimant's symptoms on the
claimant's residual functional capacity. (See paragraph (d)(4) of this
section.)
(4) Impact of symptoms (including pain) on residual functional
capacity. If the claimant has a medically determinable severe physical
or mental impairment(s), but the claimant's impairment(s) does not meet
or equal an impairment listed in Appendix 1 of this part, the Board
will consider the impact of the claimant's impairment(s) and any
related symptoms, including pain, on the claimant's residual functional
capacity. (See Sec. 220.120 of this part.)
Sec. 220.120 [Revised]
6. Section 220.120 is revised to read as follows:
Sec. 220.120 The claimant's residual functional capacity.
(a) General. The claimant's impairment(s) and any related symptoms,
such as pain, may cause physical and mental limitations that affect
what the claimant can do in a work setting. The claimant's residual
functional capacity is what the claimant can still do despite the
claimant's limitations. If the claimant has more than one impairment,
the Board will consider all of the claimant's impairment(s) of which
the Board is aware. The Board will consider the claimant's ability to
meet certain demands of jobs, such as physical demands, mental demands,
sensory requirements, and other functions, as described in paragraphs
(b), (c), and (d) of this section. Residual functional capacity is an
assessment based upon all of the relevant evidence. It may include
descriptions (even the claimant's own) of limitations that go beyond
the symptoms, such as pain, that are important in the diagnosis and
treatment of the claimant's medical condition. Observations by the
claimant's treating or examining physicians or psychologists, the
claimant's family, neighbors, friends or other persons, of the
claimant's limitations, in addition to those observations usually made
during formal medical examinations, may also be used. These
descriptions and observations, when used, must be considered along with
the claimant's medical records to enable the Board to decide to what
extent the claimant's impairment(s) keeps the claimant from performing
particular work activities. This assessment of the claimant's remaining
capacity for work is not a decision on whether the claimant is
disabled, but is used as the basis for determining the particular types
of work the claimant may be able to do despite the claimant's
impairment(s). Then, using the guidelines in Secs. 220.125 through
220.135 of this part, the claimant's vocational background is
considered along with the claimant's residual functional capacity in
arriving at a disability determination or decision. In deciding whether
the claimant's disability continues or ends, the residual functional
capacity assessment may also be used to determine whether any medical
improvement the claimant has experienced is related to the claimant's
ability to work as discussed in Sec. 220.178 of this part.
(b) Physical abilities. When the Board assesses the claimant's
physical abilities, the Board first assesses the nature and extent of
the claimant's physical limitations and then determines the claimant's
residual functional capacity for work activity on a regular and
continuing basis. A limited ability to perform certain physical demands
of work activity, such as sitting, standing, walking, lifting,
carrying, pushing, pulling, or other physical functions (including
manipulative or postural functions, such as reaching, handling,
stooping or crouching), may reduce the claimant's ability to do past
work and other work.
(c) Mental abilities. When the Board assesses the claimant's mental
abilities, the Board first assesses the nature and extent of the
claimant's mental limitations and restrictions and then determines the
claimant's residual functional capacity for work activity on a regular
and continuing basis. A limited ability to carry out certain mental
activities, such as limitations in understanding, remembering, and
carrying out instructions, and in responding appropriately to
supervision, co-workers, and work pressures in a work setting, may
reduce the claimant's ability to do past work and other work.
(d) Other abilities affected by impairment(s). Some medically
determinable impairment(s), such as skin impairment(s), epilepsy,
impairment(s) of vision, hearing or other senses, and impairment(s)
which impose environmental restrictions may cause limitations and
restrictions which affect other work-related abilities. If the claimant
has this type of impairment(s), the Board considers any resulting
limitations and restrictions which may reduce the claimant's ability to
do past work and other work in deciding the claimant's residual
functional capacity.
(e) Total limiting effects. When the claimant has a severe
impairment(s), but the claimant's symptoms, signs, and laboratory
findings do not meet or equal those of a listed impairment in Appendix
1 of this part, the Board will consider the limiting effects of all the
claimant's impairment(s), even those that are not severe, in
determining the claimant's residual functional capacity. Pain or other
symptoms may cause a limitation of function beyond that which can be
determined on the basis of the anatomical, physiological or
psychological abnormalities considered alone; e.g., someone with a low
back disorder may be fully capable of the physical demands consistent
with those of sustained medium work activity, but another person with
the same disorder, because of pain, may not be capable of more than the
physical demands consistent with those of light work activity on a
sustained basis. In assessing the total limiting effects of the
claimant's impairment(s) and any related symptoms, the Board will
consider all of the medical and nonmedical evidence, including the
information described in Sec. 220.114(c) of this part.
Sec. 220.134 [Amended]
7. Section 220.134 is amended by adding a new paragraph (d) to read
as follows:
Sec. 220.134 Medical-Vocational Guidelines in Appendix 2 of this part.
* * * * *
(d) The medical-vocational guidelines found in Appendix 2 of this
part are intended to be identical to those promulgated by the Social
Security Administration in Appendix 2 of Subpart P, 20 CFR Part 404. In
addition to Appendix 2 of this part a claimant shall also consult
Appendix 2 of 20 CFR, Subpart P, Part 404.
8. A new Sec. 220.135 is added to read as follows:
Sec. 220.135 Exertional and nonexertional limitations.
(a) General. The claimant's impairment(s) and related symptoms,
such as pain, may cause limitations of function or restrictions which
limit the claimant's ability to meet certain demands of jobs. These
limitations may be exertional, nonexertional, or a combination of both.
Limitations are classified as exertional if they affect the claimant's
ability to meet the strength demands of jobs. The classification of a
limitation as exertional is related to the United States Department of
Labor's
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classification of jobs by various exertional levels (sedentary, light,
medium, heavy, and very heavy) in terms of the strength demands for
sitting, standing, walking, lifting, carrying, pushing, and pulling.
Sections 220.132 and 220.134 of this part explain how the Board uses
the classifications of jobs by exertional levels (strength demands)
which are contained in the Dictionary of Occupational Titles published
by the Department of Labor, to determine the exertional requirements of
work which exists in the national economy. Limitations or restrictions
which affect the claimant's ability to meet the demands of jobs other
than the strength demands, that is, demands other than sitting,
standing, walking, lifting, carrying, pushing or pulling, are
considered nonexertional. Sections 220.100(b)(5) and 220.180(h) of this
part explain that if the claimant can no longer do the claimant's past
relevant work because of a severe medically determinable impairment(s),
the Board must determine whether the claimant's impairment(s), when
considered along with the claimant's age, education, and work
experience, prevents the claimant from doing any other work which
exists in the national economy in order to decide whether the claimant
is disabled or continues to be disabled. Paragraphs (b), (c), and (d)
of this section explain how the Board applies the medical-vocational
guidelines in Appendix 2 of this part in making this determination,
depending on whether the limitations or restrictions imposed by the
claimant's impairment(s) and related symptoms, such as pain, are
exertional, nonexertional, or a combination of both.
(b) Exertional limitations. When the limitations and restrictions
imposed by the claimant's impairment(s) and related symptoms, such as
pain, affect only the claimant's ability to meet the strength demands
of jobs (sitting, standing, walking, lifting, carrying, pushing, and
pulling), the Board considers that the claimant has only exertional
limitations. When the claimant's impairment(s) and related symptoms
only impose exertional limitations and the claimant's specific
vocational profile is listed in a rule contained in Appendix 2 of this
part, the Board will directly apply that rule to decide whether the
claimant is disabled.
(c) Nonexertional limitations. (1) When the limitations and
restrictions imposed by the claimant's impairment(s) and related
symptoms, such as pain, affect only the claimant's ability to meet the
demands of jobs other than strength demands, the Board considers that
the claimant has only nonexertional limitations or restrictions. Some
examples of nonexertional limitations or restrictions include the
following:
(i) Difficulty functioning because of nervousness, anxiety, or
depression;
(ii) Difficulty maintaining attention or concentrating;
(iii) Difficulty understanding or remembering detailed
instructions;
(iv) Difficulty in seeing or hearing;
(v) Difficulty in tolerating some physical feature(s) of certain
work settings, e.g., inability to tolerate dust or fumes; or
(vi) Difficulty performing the manipulative or postural functions
of some work such as reaching, handling, stooping, climbing, crawling,
or crouching.
(2) If the claimant's impairment(s) and related symptoms, such as
pain, only affect the claimant's ability to perform the nonexertional
aspects of work-related activities, the rules in Appendix 2 of this
part do not direct factual conclusions of disabled or not disabled. The
determination as to whether disability exists will be based on the
principles in the appropriate sections of the regulations, giving
consideration to the rules for specific case situations in Appendix 2
of this part.
(d) Combined exertional and nonexertional limitations. When the
limitations and restrictions imposed by the claimant's impairment(s)
and related symptoms, such as pain, affect the claimant's ability to
meet both the strength demands and demands of jobs other than the
strength demands, the Board considers that the claimant has a
combination of exertional and nonexertional limitations or
restrictions. If the claimant's impairment(s) and related symptoms,
such as pain, affect the claimant's ability to meet both the strength
demands and demands of jobs other than the strength demands the Board
will not directly apply the rules in Appendix 2 of this part unless
there is a rule that directs a conclusion that the claimant is disabled
based upon the claimant's strength limitations; otherwise the rules
provide a framework to guide the Board's decision.
Appendix 2 [Amended]
9. Appendix 2--Medical-Vocational Guidelines of part 220 is amended
by revising paragraph (c) of section 200.00 to read as follows:
Sec. 200.00 Introduction. * * *
* * * * *
(c) In the application of the rules, the individual's residual
functional capacity (i.e., the maximum degree to which the
individual retains the capacity for sustained performance of the
physical-mental requirements of jobs), age, education, and work
experience must first be determined. When assessing the person's
residual functional capacity, the Board considers his or her
symptoms (such as pain), signs, and laboratory findings together
with other evidence the Board obtains.
* * * * *
Dated: August 29, 1995.
By Authority of the Board.
Beatrice Ezerski,
Secretary to the Board.
[FR Doc. 95-22103 Filed 9-8-95; 8:45 am]
BILLING CODE 7905-01-P
