Ill. Admin. Code tit. 89, § 845.20 - Steps of Sequential Evaluation

a) The Bureau incorporates the criteria specified in the Code of Federal Regulations 20 CFR 404.1520-1520 a, 404.1581, and 416.981 revised April 1, 1989; 20 CFR 416.920, 416.923, 416.924 - 416.924 f, 416.926 - 416.926 c revised February 11, 1991; Social Security Rulings 86-8 (Titles II and XVI: The Sequential Evaluation Process) as Effective December 1, 1984; Social Security Ruling 91-3p (Title II: Determining Entitlement to Disability Benefits for Months Prior to January 1991 for Widows, Widowers, and Surviving Divorced Spouse Claims) as effective May 22, 1991; Section 5103 of the Omnibus Budget Reconciliation Act of 1990 ( P.L. 101-508 ) as effective January 1, 1991.

b) The steps are as follows:

1) Is the individual engaging in substantial gainful activity?

A) The Bureau incorporates the criteria for determining substantial gainful activity specified in the Code of Federal Regulations 20 CFR 404.1510, 404.1571 -1576, 404.1591 -1592, 416.910 and 416.971 -976 revised April 1, 1989; Social Security Rulings 83-33 (Titles II and XVI: Determining Whether Work Is Substantial Gainful Activity - Employees), 83-34 (Titles II and XVI: Determining Whether Work Is Substantial Gainful Activity - Self-Employed Persons), 83-35 (Titles II and XVI: Averaging of Earnings in Determining Whether Work Is Substantial Gainful Activity) as Issued 1983; and 85-5c (Disabled Child's Benefits - Determining Whether Work Is Substantial Gainful Activity - Averaging Earnings from Employment) as Issued in Anderson vs. Heckler 762 F. 2nd 455 (8th Cir. 1984).

B) If the individual is performing substantial gainful activity, a determination that the individual is not disabled will be made regardless of the individual's medical condition, age, education, or work experience unless the individual meets the blindness provisions specified in 20 CFR 404.1581 as amended February 8, 1983, 20 CFR 404.1582 revised April 1, 1986, 20 CFR 404.1583 revised April 1, 1986, 20 CFR 404.1584 as amended May 16, 1983, 20 CFR 416.981, 20 CFR 416.982, 20 CFR 416.983 and 20 CFR 416.984 revised April 1, 1986.

C) According to Program Operations Manual System (POMS) Disability Insurance (DI) 24001, 24005, and 24010 revised June, 1987, the Social Security Administration Field Offices will have jurisdiction over work issue cases, that is, cases where there is an indication that a claimant is or has engaged in work activity during a period when disability was alleged or determined.

2) Does the individual have a severe impairment?

The Bureau incorporates the provisions for determining whether an impairment is or is not severe as specified in 20 CFR 404.1520(c), 20 CFR 404.1521, and 20 CFR 416.920(c), as revised April 1, 1987; and 20 CFR 416.921 as revised February 11, 1991.

3) Does the individual have an impairment(s) that meets or equals the Listing of Impairments?

A) The Bureau incorporates the following criteria for the Listing of Impairments:

i) Code of Federal Regulations 20 CFR 404.1525, 416.925, 404 Appendix 1 to Subpart P revised April 1, 1989;

ii) POMS DI 24525.000 Evaluation of Acquired Immunodeficiency Syndrome (AIDS) and AIDS-Related Complex (ARC) revised February 1990; POMS DI 24530.000 Evaluation of Musculoskeletal Issues revised February 1988; POMS DI 24540.000 Evaluation of Specific Issues - Respiratory revised February 1989; POMS DI 24545.001 Postmyocardial Infarction Cases revised September 1988; POMS DI 24560.001 Evaluation of Chronic Myelogenous Leukemia and POMS DI 24580.000 Evaluation of Specific Issues - Neurological revised February 1988; and POMS DI 24575.000 Evaluation of Specific Issues - Multiple Body Systems revised March 1991;

iii) With regard to the claims being reviewed under the Morrison, Doe and Decker class action lawsuit, the court-ordered criteria for evaluating drug addiction and alcoholism as specified in POMS DI 32551.000 et seq. revised August 1990.

B) The Bureau incorporates the criteria for medical equivalence specified in the Code of Federal Regulations 20 CFR 404.1526 as revised April 1, 1989 and 20 CFR 416.926 as revised Feburary 11, 1991.

C) If the individual has an impairment that is determined to meet the duration requirement and is listed in the Listing of Impairments or equal to a listed impairment, a determination that the individual is disabled will be made regardless of the individual's age, education, or work experience unless the individual meets the criteria specified in 89 Ill. Adm. Code 845.20(b)(1)(B).

4) Does the individual's impairment prevent him/her from doing past relevant work?

A) The Bureau incorporates the criteria for evaluation of residual functional capacity and past work as specified in the Code of Federal Regulations 20 CFR 404.1545, 404.1546, 416.945 and 416.946 revised April 1, 1989; Social Security Rulings 82-40 (Titles II and XVI: The Vocational Relevance of the Past Work Performed in a Foreign Country) as Effective May 14, 1982; 82-52 (Titles II and XVI: Duration of the Impairment), 82-53 (Titles II and XVI: Basic Disability Evaluation Guides), 82-56 (Titles II and XVI: The Sequential Evaluation Process), 82-61 (Titles II and XVI: Past Relevant Work - The Particular Job or Occupation as Generally Performed), 82-62 (Titles II and XVI: A Disability Claimant's Capacity To Do Past Relevant Work, In General) as Effective August 20, 1980; 85-16 (Titles II and XVI: Residual Functional Capacity for Mental Impairments), 85-28 (Titles II and XVI: Medical Impairments That Are Not Severe) as Issued 1985. With regard to claims being reviewed under the Hyatt class action lawsuit, the Bureau also incorporates the court-ordered criteria for evaluating allegations of hypertension or diabetes as specified in POMS DI 32548.000 et seq. revised September 1990 and January 1991.

B) If the individual has an impairment that cannot be evaluated on medical findings alone, then the residual functional capacity will be reviewed along with the physical and mental demands of the past work. This review will be conducted by a Bureau disability examiner as specified in 20 CFR 404.1520(e) amended March 5, 1985, 20 CFR 404.1615 revised April 1, 1986, 20 CFR 416.920(e) amended March 5, 1985, and 20 CFR 416.1015 amended May 29, 1981, and August 19, 1981.

C) If the individual can still do this kind of work, a determination that the individual is not disabled will be made.

5) Does the individual's impairment prevent him/her from doing other work?

A) The Bureau incorporates the criteria for vocational considerations specified in the Code of Federal Regulations 20 CFR 404.1560 -1568 and 416.960 -968 revised April 1, 1989; Social Security Rulings 82-41 (Titles II and XVI: Work Skills and Their Transferability as Intended by the Expanded Vocational Factors Regulations as Effective August 20, 1980), and 82-63 (Titles II and XVI: Medical-Vocational Profiles showing an Inability to Make an Adjustment to Other Work) as Effective August 20, 1980.

B) The Bureau incorporates the criteria for medical-vocational guidelines specified in the Code of Federal Regulations 20 CFR 404.1569, 20404 Appendix 2 and 20 CFR 416.969 revised April 1, 1986; Social Security Rulings 83-10 (Title II and XVI: Determining Capability To Do Other Work - The Medical-Vocational Rules of Appendix 2), 83-11 (Titles II and XVI: Capability To Do Other Work - The Exertionally Based Medical-Vocational Rules Met), 83-12 (Titles II and XVI: Capability To Do Other Work - The Medical Vocational Rules As a Framework for Evaluating Exertional Limitations Within a Range of Work or Between Ranges of Work), 83-14 (Titles II and XVI: Capability To Do Other Work - The Medical - Vocational Rules As a Framework for Evaluating a Combination of Exertional and Nonexertional Impairments), and 85-15 (Titles II and XVI: Capability To Do Other Work - The Medical - Vocational Rules As a Framework for Evaluating Solely Nonexertional Impairments) as effective August 20, 1980. With regard to claims being reviewed under the Morrison, Doe and Decker class action lawsuit, the Bureau also incorporates the court-ordered criteria for evaluating residual functional capacity and making individualized vocational assessments as specified in POMS DI 32551.000 et seq. revised August 1990.

C) If the individual has an impairment that cannot be evaluated on medical findings alone, prevents him/her from performing past work but does not prevent him/her from doing other work, a determination that the individual is not disabled will be made.

D) If the impairment prevents him/her from doing other work, a determination that the individual is disabled will be made.

c) When a fully or partially unfavorable determination has been made, an individual may request an administrative and judicial review of the determination according to the process described in the Code of Federal Regulations 20 CFR 404.900 and 20 CFR 416.1400 revised April 1, 1986.

d) The Bureau will make disability determinations according to the criteria specified in the code of Federal Regulations 20 CFR 404.1615 revised April 1, 1986 and 20 CFR 416.1015 as amended May 29, 1981 and August 19, 1981.

Notes

Ill. Admin. Code tit. 89, § 845.20

Amended at 16 Ill. Reg. 2615, effective February 4, 1992