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