Rev. 12/04

§ P 600. Application of MedicalVocational Guidelines (Grid) – In General

For disability benefit claimants who do not have listed impairments or their equivalent but who also lack the residual functional capacity to do their past relevant work a determination on disability requires consideration of age, education, and past work experience.  The question is whether the claimant’s impairments combined with these other factors leave the individual unable to do work that exists in the national economy.

The regulations contain a set of Medical-Vocational Guidelines.  These guidelines provide a matrix in which claimants are located according to residual functional capability, age, education, and past work experience.

For any given combination of these factors, the guidelines specify a determination of “disabled” or “not disabled.”  According to the regulations these determinations rest on analysis of vocational information and therefore eliminate the need for vocational expert testimony in cases to which the guidelines apply.  Cases that do not fall within the guidelines either because they involve impairments not reflected in their residual functional capacity categories or because they fall between the categories into which the other factors are broken down require an ad hoc consideration of the claimants’ ability to do work in the national economy.

§ P 610. Application of MedicalVocational Guidelines (Grid) – Non-Exertional Impairments

Since the Medical-Vocational Guidelines define residual functional capacity in terms of such physical abilities as lifting, standing, and moving about their application to individuals with mental impairments or pain or sensitivity to environmental factors would fail to account for the full extent of impairment.  If a claimant suffers from a significant non-exertional impairment a decision based on the guidelines that he or she is not disabled is not normally justified.  In such a case, the Agency must have vocational expert testimony or similar evidence that there are jobs in the national economy which a person with the full range of the claimant’s impairments, including the non-exertional ones, can perform.  Social Security Ruling SSR No. 87-19c allows the use of the guidelines as a framework in cases of non-exertional impairments when there is also vocational expert testimony.

Whether or not an individual’s non-exertional impairments force a decision outside the guidelines depends on the extent to which the level of those impairments would affect the claimant’s ability to perform the range of jobs in the otherwise relevant category (sedentary work, light work, etc.).  When non-exertional impairments reduce the individual’s capacity for work only marginally, the guidelines can still form the basis of a determination and testimony of a vocational expert may not be necessary.

Social Security Ruling SSR No. 85-15 draws attention to the demands of unskilled work, including the ability to understand, carry out, and remember simple instructions; to respond appropriately to supervision, co-workers, and normal work situations; to deal with changes in routine.  When a mental or other non-exertional impairment causes a substantial loss in any of these dimensions it justifies a finding of disability despite a contrary indication based simply on the claimant’s age, education, and work experience.

Social Security Ruling SSR No. 96-4p stresses that it is not the nature of the individual’s symptoms themselves that qualify as exertional or non-exertional but rather the functional limitations or restrictions that they produce.

Because evidence of significant non-exertional impairments can provide a means of avoiding a “not disabled” determination otherwise directed by the guidelines, when the Agency has ruled against a claimant with such impairments improper use of the guidelines is frequently argued on appeal.

Rev. 11/07

§ P 620. Claimant’s Residual Functional Capacity

A claimant’s “residual functional capacity” is a full summary of the ability to work the claimant has left after taking account of his or her impairments.  It rests on a consideration of all impairments, physical and mental, exertional and non-exertional.  As disability decisions are divided into medical and vocational elements, residual functional capacity falls on the medical side.  Medical evidence and even medical judgments bear on an individual’s residual functional capacity.  But in addition, the claimant’s own testimony and that of others about the claimant’s remaining physical and mental abilities must be considered.  Social Security Ruling SSR No. 96-8p lays out how the Agency assesses an individual’s residual functional capacity.

Once determined the claimant’s residual functional capacity is compared to his or her past relevant work or other work in the national economy.  Social Security Ruling SSR No. 96-9p deals with that stage of the disability determination and cases where the claimant is limited by residual functional capacity to less than the full range of  sedentary work.

An amendment to the Act in 1996 removed the statutory language supporting this individualized assessment.

Rev. 9/96

§ P 630. Application of Medical-Vocational Guidelines (Grid) – Age

Age is one of the vocational factors listed in the Act’s definition of disability.  It is incorporated in the Medical-Vocational Guidelines through three age categories: younger person (under 50); person approaching advanced age (50-54); and person of advanced age (55 or over).  A subgroup of the latter category is: person closely approaching retirement age (60 or over).  The purpose of including age is its assumed connection to a person’s ability to adapt to new work situations.  The regulations do say that these age categories should not be applied mechanically in borderline situations.

Since moving from one age category to another can change the guidelines’ directed decision from “not disabled” to “disabled,” the mere delay in processing an appeal can, in theory, change its outcome.

Because of the phased increase in “full retirement age” from 65 to 67 increasing numbers of individuals older than 65 will be eligible for disability benefits and find it advantageous to claim them instead of old age insurance.  (Claiming old age insurance benefits prior to the worker’s “full retirement age” produces a reduction in the monthly amount.)  Social Security Ruling SSR No. 03-3p addresses treatment of initial disability claims brought by individuals in this age range.

Rev. 12/03

§ P 640. Application of Medical-Vocational Guidelines (Grid) – Education

Education is one of the vocational factors listed in the Act’s definition of disability.  It is incorporated in the Medical-Vocational Guidelines through four categories: illiteracy, marginal education (6th grade or less), limited education (7th grade through 11th grade), high school and above (at least through 12th grade).  In addition, the regulations specify that an inability to communicate in English should be taken account of in considering what work a person with the claimant’s residual functional capacity can do.

While the educational categories are expressed in terms of formal education, they are also defined in terms of skills.  The regulations state that a claimant’s formal education level need not be determinative.  A person with a lack of formal education can be shown to have a high level of education, and the reverse is also true.

§ P 650. Application of Medical-Vocational Guidelines (Grid) – Work Experience

Work experience is one of the vocational factors listed in the Act’s definition of disability.  It is incorporated in the Medical-Vocational Guidelines through several categories.  First, there is a special provision for those whose long-term work experience has been hard unskilled physical labor.  The guidelines employ three experience categories: skilled, semi-skilled, and unskilled.  In addition, the guidelines provide for individuals with no work experience.  In connection with the skilled and semi-skilled work categories, the degree of transferability of the skills involved can also be a factor.

In determining how to categorize a claimant’s work experience the focus is on work of reasonable duration within the past 15 years.

§ P 660. Application of MedicalVocational Guidelines (Grid) – Work Level (Light, Sedentary, etc.)

The Medical-Vocational Guidelines divide the exertional requirements of work into five categories, defined in terms of such activities as lifting (frequency and types of items), carrying, standing, sitting, and walking.  The five levels are: sedentary work, light work, medium work, heavy work, and very heavy work.  The categories are largely cumulative so that if a person can do heavy work, the guidelines assume an ability to do medium, light, and sedentary work.

Social Security Ruling SSR No. 83-10 fills in important details of the exertional requirements of the five categories.  For example, it explains that an individual able to perform the “full range” of sedentary work must be able to sit approximately six hours out of an eight-hour day and stand or walk the remaining two hours.  It also explains that most unskilled sedentary jobs require good use of both hands in repetitive hand-finger activity. Comparable details are provided for the other categories.  Social Security Ruling SSR No. 83-12 notes that unskilled jobs are not ordinarily structured so that the worker can sit or stand at will.  If medical evidence indicates that the only way the individual can get through a full workday is by alternating between sitting and standing at will, it follows that the individual cannot perform the “full range” of sedentary work.

§ P 680. Application of Medical-Vocational Guidelines (Grid) – Transferable or Marketable Skills

Semi-skilled or skilled work experience may or may not produce skills that can be used in other types of work.  Whether the skills are transferable depends on the similarity of work activities involved.  Some jobs involve such a specialized setting (mining, agriculture, fishing) that their skills are not viewed as transferable.

Social Security Ruling SSR No. 82-41 adds detail to the definition of transferability found in the regulations.

A different concept of “highly marketable skills” applies to claimants close to retirement age (60-64).  Claimants in that age range with severe impairments are not considered able to adjust to sedentary or light work unless they have skills that are highly marketable.

Rev. 6/95

Especially Difficult Types of Impairment

§ P 710. Mental Impairment, Psychological Problems

The Act’s disability standard includes both physical and mental impairments.  Cases involving the latter are, as a class, more difficult to evaluate.  The regulations now lay out a procedure or approach for evaluating mental impairments.  In addition, the Listing of Medical Impairments includes categories of mental impairment.  Social Security Ruling SSR No. 85-16 provides guidelines for determining residual functional capacity in cases where the claimant’s mental impairment(s) do not meet or equal the listing.  Social Security Ruling SSR No. 85-15 treats the relationship between such impairments and the Medical-Vocation Guidelines.  It also contains a discussion of the impact of workplace stress, noting that individuals with mental impairments may function successfully in a restricted environment but fail to deal effectively with the demands of getting to work regularly and receiving supervision.

Cases in which mental impairments pose special difficulty include cases in which the claimant is seeking to establish onset of disability before insured status was lost but no contemporary mental health evaluations are available, cases in which the claimant’s mental impairments interfere with presenting the disability claim to the Agency, cases in which the manifestation of mental illness is episodic, and cases in which a degree of mental impairment is but one of a complex of impairments.

§ P 720. Mental Retardation, Limited I.Q.

The Act’s disability standard includes both physical and mental impairments.  Mental impairments include not only psychological conditions but limited intellectual functioning or mental retardation.  The extent of intellectual impairment can also provide evidence of other categories of mental impairment.  The regulations now lay out a procedure or approach for evaluating mental impairments, including cases of mental retardation.  In addition, the Listing of Medical Impairments includes mental retardation.

Rev. 12/01

§ P 730. Impaired Vision, Blindness

The Act provides a detailed definition of blindness.  Its test is central visual acuity of 20/200 or less in the better eye with glasses or a field of vision limited to 20 degrees or less.  The Listing of Medical Impairments include additional forms and measures of visual impairment.

§ P 740. Pain or Other Subjective Complaints

Pain and such other subjective impairments as dizziness and drowsiness create great difficulty for disability claimants and the Agency.  The Act requires that a disability be medically determinable.  That does not mean that the particular manifestation of a medical condition be measurable by medical tests.  It does, however, exclude problems that have no evident basis in a medical condition.  Determining whether a person’s complaints of pain have a sufficient medical connection is one of the most frequently litigated Social Security issues.  Since judgments about the claimant’s credibility go to the core of a disability claim of this type, the issue is often framed in those terms.  Where there is medical evidence of a condition that is consistent with the subjective complaints and their severity, some courts require the Agency to explain its grounds for rejecting the claimant’s testimony about pain or similar impairments.

The different circuits of the U.S. Court of Appeals have all addressed the problem.  Their formulations vary but they are similar in recognizing that a disability determination can rest heavily on the claimant’s own testimony about subjective complaints, but that some medical evidence is necessary.

In November 1991 the Agency issued revised and expanded regulations dealing with this subject.  It followed those regulations with a new Social Security Ruling, SSR No. 95-5p, issued in October 1995.  That ruling superseded two earlier ones, SSR No. 88-13 and SSR No. 90-1p, that dealt with the evaluation of subjective complaints and associated questions of weighing the credibility of claimant testimony.  In 1996 the Agency gathered its policies on these related matters into SSR No. 96-7p which in turn superseded SSR No. 95-5p.

Rev. 9/96

§ P 750. Alcoholism or Drug Addiction

Alcoholism and other substance addictions pose distinct disability problems.  Prior to a 1996 amendment, however, they were assessed like other sources of disability.  Alcoholism and drug addiction could qualify as disabilities apart from any other physical or mental impairment and also be a major contributing element in cases involving other impairments.

Under the Act prior to the 1996 amendment, some courts even placed an affirmative duty on the Agency to develop further medical evidence in cases where there was some evidence of substance abuse despite a claimant’s denial of the condition.

Social Security Ruling SSR No. 82-60 covers evaluation of disability claims involving drug addiction or alcoholism under pre-amendment law.

The 1996 amendment radically changed the law on this point.  Under its provisions neither alcoholism nor drug addiction can be an independent basis for a disability determination; further, neither can be a major contributing factor to such a determination.  The amendment applied to new applications immediately and to then current beneficiaries as of January 1, 1997.

SSI recipients who suffer alcoholism or drug addiction have been subject to specific requirements of participation in treatment programs as a condition of eligibility.  Amendments to the Act in 1994 extended these requirements to Title II disability recipients and added a number of other provisions focused on cases where alcoholism or drug addiction is a contributing factor to disability benefit entitlement.  Under the 1996 change in eligibility there will be far fewer beneficiaries with alcoholism or drug addiction, but those with such a condition must be referred for treatment and if incapable of managing benefits receive them through a representative payee.

Rev. 6/96

§ P 760. Multiple or Combined Impairments

When a claimant has several medical problems none of which is by itself disabling, he or she may still qualify for disability benefits.  Multiple impairments, including combined physical and mental impairments, must be considered in terms of their cumulative effect on the individual’s ability to work.  A determination which simply deals with medical problems one-by-one may be defective on this ground.

This cumulative approach toward multiple impairments applies not only to the threshold question of whether the individual has impairments of sufficient severity to warrant consideration of vocational factors but also to all subsequent stages of the evaluation.

The regulations do, however, distinguish the case in which two unrelated medical problems follow one another in time.  In such a case the Agency will not combine the impairments for purposes of applying the 12-month duration test.

Issues of Medical Evidence

§ P 800. Issues of Medical Evidence – In General

Under the Act the Agency has the ultimate responsibility for determining disability.  It is not bound by the judgments of other bodies administering related benefit programs nor by the testimony of a physician who characterizes the claimant as “disabled” or “unable to work.”

It is generally stated that an administrative law judge (ALJ) hearing a disability benefit appeal has the responsibility for weighing all the medical evidence and that the claimant has the burden of proof in establishing the existence and degree of his or her physical and mental impairments.  It is also generally stated that an ALJ cannot substitute his or her own medical opinion for those of medical professionals or interpret raw medical data without expert assistance.  Issues of proper treatment of medical evidence arise when an Agency decision is appealed to Federal district court and it is argued that the ALJ’s decision is not supported by the record.  In that setting courts have established some more detailed guidelines on proper treatment and weight for certain types of medical evidence in relation to others.  Most widespread among these guidelines are the positions of the various circuits of the U.S. Court of Appeals on the weight to be given testimony by treating physicians.  Another has to do with determinations by other agencies.  While not being bound by the determinations of other Federal agencies administering disability programs (like the Veterans Administration), SSA must give them some weight.  Courts have refused to affirm ALJ decisions that failed to give explicit consideration to such findings.

The Agency issued new regulations dealing with medical evidence in August 1991.

Social Security Ruling SSR No. 96-4p draws a distinction between symptoms and impairments.  It notes that no symptom or set of symptoms can, alone, establish disability.  There must be medical signs or laboratory findings of a “medically determinable” physical or mental impairment.

Rev. 9/98

§ P 810. Issues of Medical Evidence – Treating Physician

While the Agency has the ultimate responsibility for evaluating the claimant’s medical condition, courts have held that the Agency and an administrative law judge (ALJ) hearing an appeal must give special weight or attention to reports and testimony from a physician who has treated the claimant.  Such testimony and reports are distinguished from those coming from physicians who have simply examined the claimant in order to evaluate his or her condition for purposes of the claim.

The different circuits of the U.S. Court of Appeals hold different views on how the Agency should weigh treating physician testimony, on when the rule applies, and on whether it extends to the physician’s ultimate conclusion about the claimant’s condition.

Regulations on treatment of medical evidence issued by the Agency in August 1991 purport to codify or replace these judicial interpretations.

Social Security Ruling SSR No. 96-2p elaborates on those regulations, focusing on when medical opinions of a treating source are entitled to controlling weight.  SSR No. 96-5p draws a sharp distinction between medical opinions and opinions of a treating source on issues that bear directly on eligibility such as whether an individual has a listed impairment, what residual functional capacity is possessed by an individual, or whether a claimant’s residual functional capacity prevents the individual from performing past relevant work.  SSR No. 06-3p lays out a distinction between "acceptable medical sources" and other medical sources and how evidence from these two categories should be considered. It also addresses the weight to be given disability determinations made by other agencies for other purposes.

Rev. 11/07

§ P 820. Issues of Medical Evidence – Non-Examining Physician

When an administrative law judge (ALJ) hears a disability benefit appeal, the record may include a report from a Medical Expert (ME), a physician who has not examined the claimant but has simply reviewed the reports, tests, and other medical evidence provided by others.  The extent to which the ALJ may rely on the testimony or report of such a non-examining physician, particularly when it rejects the diagnosis or conclusion of medical personnel who have examined or even treated the claimant, can be a critical issue.

The use of a Medical Expert is left to the ALJ’s discretion.  While use of a ME may occur before, during or after a hearing, ALJs are directed to avoid off-the-record exchange with such a physician.  The appropriate role of such an expert is providing impartial assessment of the available medical evidence in response to specific questions from the ALJ or the claimant.

Regulations on treatment of medical evidences issued by the Agency in August 1991 deal with this among many other issues.

Social Security Ruling SSR No. 96-6p deals with the treatment of findings and opinions of State agency medical and psychological consultants and other program medical personnel by adjudicators at later stages in the claims process, specifically the ALJ and Appeals Council.

Rev. 9/96

§ P 830. Issues of Medical Evidence – Need for a Medical Exam

The role of a medical examination or particular medical tests in establishing physical or mental impairments can be a disputed issue.  The issue can arise in one of several different ways.  With some conditions, Agency policy or an administrative law judge (ALJ) opinion may take the view that impairment cannot be established without the results of a particular test or procedure.  Other symptoms or medical evidence will not suffice.  Such a position must ultimately find support in the Act’s reference to “medically acceptable clinical and laboratory diagnostic techniques.”  It is usually invoked when the individual has been examined or tested, and the results do not meet a particular threshold.  The claimant’s refusal to submit to a medical examination or test can also raise the issue.

The need for a medical examination or particular test may under different circumstances be raised by the claimant.  Courts have held that claimants with some medical conditions (significant signs of mental illness, for example) should be given a consultative examination as part of the disability evaluation process.  Regulations issued in 1991 cover the standards to be used in determining whether or not to order and pay for such a consultative examination. Courts have not left their use totally to Agency discretion.

§ P 840. Issues of Medical Evidence – Failure to Obtain Treatment or Use Medication

When prescribed medical treatment ranging from surgery to medication would remove an impairment, restoring the claimant’s ability to work, a failure to follow such treatment can lead to a finding that the claimant is not disabled.  The regulations recognize a variety of valid reasons for failing to follow prescribed treatment.  They run from religious conviction to concern about the riskiness of the procedure.  In addition, courts have recognized practical limits on the requirement, observing that when claimants are financially or psychologically unable to pursue treatment, their failure to do so should not be held against them.

Social Security Ruling SSR No. 82-59, which covers this topic, notes specifically that the claimant’s inability to pay for treatment excuses the failure to obtain it.  Social Security Ruling SSR No. 87-6, dealing with epilepsy,  concludes that treatment can, in most cases, allow an epileptic to engage in substantial gainful activity.  The ruling focuses on the need to determine whether the claimant’s seizures are the consequence of a failure to continue medical care or take prescribed medication.

§ P 850. Issues of Medical Evidence – Side Effects of Treatment or Medication

When a claimant’s medical impairments call for a course of treatment or medication with side effects, those side effects themselves must be considered along with the underlying impairments in determining the individual’s residual functional capacity.  In the course of focusing on the nature and extent of impairments and developing medical evidence, this dimension is sometimes overlooked.

§ P 860. Issues of Medical Evidence – Treatment of New Medical Evidence

During the Agency’s evaluation of a disability benefit claim new evidence can be submitted at each stage of review.  In particular, the hearing before an administrative law judge (ALJ) allows full development of evidence that was not presented or available at earlier stages.  The regulations provide that even the Appeals Council may consider new and material evidence so long as it relates to the period up through the ALJ hearing.

Whether the Agency considers evidence submitted after an ALJ hearing or whether a Federal district court remands the cases so that the Agency can consider new medical evidence are largely discretionary matters.

Establishing the Availability of Work Claimant Can Perform

§ P 900. Establishing the Availability of Work Claimant Can Perform – In General

Once a claimant has established that he or she cannot perform past relevant work, the next issue is whether there is work available in the national economy that a person with the claimant’s residual functional capacity can perform.

In cases properly resolved under the Medical-Vocational Guidelines, the guidelines themselves embody the necessary evidence of work availability of which the Agency has taken administrative notice.

In cases that fall outside the guidelines evidence of work the claimant can perform must come from other sources.  An agency decision that the claimant is not disabled that does not rest on such evidence will generally be overturned.  Social Security Ruling SSR No. 96-9p focuses on treatment of cases in which the claimant’s residual functional capacity assessment indicates an ability to perform less than a full range of sedentary work.

The issue of how many positions it takes to meet the Act’s test of “substantial gainful work which exists in the national economy . . . in significant numbers” has eluded resolution.

Rev. 9/96

§ P 910. Establishing the Availability of Work Claimant Can Perform – Dictionary of Occupational Titles

The Dictionary of Occupational Titles published by the Department of Labor is frequently used by the Agency, in combination with other government information, in determining the availability of work.  The regulations provide that the Agency can take administrative notice of such information in determining whether there is work available in the national economy that a person with the claimant’s residual functional capacity can perform.

The Dictionary of Occupational Titles can also be used when the issue concerns the claimant’s ability to perform past relevant work.  In such a case, it may assist in categorizing the claimant’s past work in terms of required functional capacity.

Finally, it can be used to challenge a vocational expert’s testimony concerning the available of work the claimant can perform.  It can be used in this way if the Dictionary of Occupation Titles indicates that the cited jobs require capacities the claimant lacks.

Rev. 3/95

§ P 920. Establishing the Availability of Work Claimant Can Perform – Vocational Expert Testimony or Report

In cases falling outside the Medical-Vocational Guidelines, it is common to use a vocational expert to testify on the availability of work that can be performed by individuals with the claimant’s skills and residual functional capacity.  Indeed, expert testimony is probably required in most such cases if the Agency is to meet the burden of coming forward with vocational evidence that courts have placed on it.

The regulations simply state that such specialists may be used at the discretion of the Agency.  Social Security Ruling SSR No. 00-4p provides more detailed agency policy on the use of vocation expert evidence.

Nothing, of course, prevents claimants from producing experts of their own at a disability benefit hearing.

Rev. 12/03

§ P 930. Establishing the Availability of Work Claimant Can Perform – Hypotheticals Posed to the Vocational Expert

When a vocational expert is used at a disability benefit hearing, the expert’s testimony concerns the number and range of jobs available to individuals with residual functional capacities like those of the claimant.  Since that testimony comes before the administrative law judge (ALJ) has reached a conclusion on the precise extent of the claimant’s impairments and the vocational expert is not in a position to make medical judgments, the testimony is commonly framed in terms of hypothetical individuals with impairments like those the claimant may be found to have.

When the hypotheticals on which the vocational expert testifies fail to include all elements of the claimant’s medical condition, courts may hold that an ALJ’s determination resting on that testimony is not supported by substantial evidence.