20 CFR 404.1615 - Making disability determinations.

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§ 404.1615 Making disability determinations.

(a) When making a disability determination, the State agency will apply subpart P, part 404, of our regulations.

(b) The State agency will make disability determinations based only on the medical and nonmedical evidence in its files.

(c) Disability determinations will be made by:

(1) A State agency medical or psychological consultant and a State agency disability examiner;

(2) A State agency disability examiner alone when there is no medical evidence to be evaluated (i.e., no medical evidence exists or we are unable, despite making every reasonable effort, to obtain any medical evidence that may exist) and the individual fails or refuses, without a good reason, to attend a consultative examination (see § 404.1518);

(3) A State agency disability examiner alone if the claim is adjudicated under the quick disability determination process (see § 404.1619) or the compassionate allowance process (see § 404.1602), and the initial or reconsidered determination is fully favorable to you. This paragraph will no longer be effective on November 11, 2016 unless we terminate it earlier or extend it beyond that date by publication of a final rule in the Federal Register; or

(4) A State agency disability hearing officer.

See § 404.1616 for the definition of medical or psychological consultant and § 404.915 for the definition of disability hearing officer. The State agency disability examiner and disability hearing officer must be qualified to interpret and evaluate medical reports and other evidence relating to the claimant's physical or mental impairments and as necessary to determine the capacities of the claimant to perform substantial gainful activity.
See § 404.1572 for what we mean by substantial gainful activity.

(d) An initial determination by the State agency that an individual is not disabled, in any case where there is evidence which indicates the existence of a mental impairment, will be made only after every reasonable effort has been made to ensure that a qualified psychiatrist or psychologist has completed the medical portion of the case review and any applicable residual functional capacity assessment. (See § 404.1616 for the qualifications we consider necessary for a psychologist to be a psychological consultant and § 404.1617 for what we mean by “reasonable effort”.) If the services of qualified psychiatrists or psychologists cannot be obtained because of impediments at the State level, the Commissioner may contract directly for the services. In a case where there is evidence of mental and nonmental impairments and a qualified psychologist serves as a psychological consultant, the psychologist will evaluate only the mental impairment, and a physician will evaluate the nonmental impairment.

(e) The State agency will certify each determination of disability to us on forms we provide.

(f) The State agency will furnish us with all the evidence it considered in making its determination.

(g) The State agency will not be responsible for defending in court any determination made, or any procedure for making determinations, under these regulations.

[52 FR 33926, Sept. 9, 1987, as amended at 56 FR 11018, Mar. 14, 1991; 61 FR 11135, Mar. 19, 1996; 62 FR 38452, July 18, 1997; 65 FR 34958, June 1, 2000; 75 FR 62682, Oct. 13, 2010; 78 FR 66639, Nov. 6, 2013; 79 FR 51243, Aug. 28, 2014; 80 FR 63093, Oct. 19, 2015]

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].

It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.

United States Code
U.S. Code: Title 31 - MONEY AND FINANCE

§ 401 - Trust Funds

§ 402 - Old-age and survivors insurance benefit payments

§ 403 - Reduction of insurance benefits

§ 404 - Overpayments and underpayments

§ 405 - Evidence, procedure, and certification for payments

§ 405 note - Evidence, procedure, and certification for payments

§ 406 - Representation of claimants before Commissioner

§ 409 - “Wages” defined

§ 410 - Definitions relating to employment

§ 410a - Transferred

§ 411 - Definitions relating to self-employment

§ 412 - Self-employment income credited to calendar years

§ 413 - Quarter and quarter of coverage

§ 414 - Insured status for purposes of old-age and survivors insurance benefits

§ 415 - Computation of primary insurance amount

§ 416 - Additional definitions

§ 417 - Benefits for veterans

§ 418 - Voluntary agreements for coverage of State and local employees

§ 418 note - Voluntary agreements for coverage of State and local employees

§ 421 - Disability determinations

§ 421 note - Disability determinations

§ 422 - Rehabilitation services

§ 423 - Disability insurance benefit payments

§ 424a - Reduction of disability benefits

§ 425 - Additional rules relating to benefits based on disability

§ 428 - Benefits at age 72 for certain uninsured individuals

§ 429 - Benefits in case of members of uniformed services

§ 430 - Adjustment of contribution and benefit base

§ 431 - Benefits for certain individuals interned by United States during World War II

§ 433 - International agreements

§ 902 - Commissioner; Deputy Commissioner; other officers

§ 902 note - Commissioner; Deputy Commissioner; other officers

§ 909 - Delivery of benefit checks

§ 1320a-6

§ 1320a-8a

§ 1320b-13

§ 1320b-17

Statutes at Large

Title 20 published on 2015-04-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 20 CFR Part 404 after this date.

  • 2015-10-30; vol. 80 # 210 - Friday, October 30, 2015
    1. 80 FR 66843 - Vocational Factors of Age, Education, and Work Experience in the Adult Disability Determination Process; Extending of the Comment Period
      GPO FDSys XML | Text
      Advance notice of proposed rulemaking; extension of the comment period.
      The comment period for the advanced notice of proposed rulemaking published on September 14, 2015 (80 FR 55050), is extended. To ensure that your written comments are considered, we must receive them on or before December 14, 2015.
      20 CFR Parts 404 and 416