[Federal Register: October 20, 2003 (Volume 68, Number 202)]
[Notices]
[Page 59971-59976]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr20oc03-74]
-----------------------------------------------------------------------
SOCIAL SECURITY ADMINISTRATION
[Social Security Ruling, SSR 03-2p]
Titles II and XVI: Evaluating Cases Involving Reflex Sympathetic
Dystrophy Syndrome/Complex Regional Pain Syndrome
AGENCY: Social Security Administration.
ACTION: Notice of Social Security Ruling.
-----------------------------------------------------------------------
SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of
Social Security gives notice of Social Security
[[Page 59972]]
Ruling, SSR 03-2p. This Ruling explains the policies of the Social
Security Administration for developing and evaluating title II and
title XVI claims for disability on the basis of Reflex Sympathetic
Dystrophy Syndrome (RSDS), also frequently known as Complex Regional
Pain Syndrome, Type I (CRPS). These terms are synonymous and are used
to describe a unique clinical syndrome that may develop following
trauma. This syndrome is characterized by complaints of intense pain
and typically includes signs of autonomic dysfunction.
EFFECTIVE DATE: October 20, 2003.
FOR FURTHER INFORMATION CONTACT: Carolyn Kiefer, Office of Disability
Programs, Social Security Administration, 6401 Security Boulevard,
Baltimore, MD 21235-6401, (410) 965-9104 or TTY (410) 966-5609. For
information on eligibility or filing for benefits, call our national
toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or visit our
Internet Web site, Social Security Online, at http://www.socialsecurity.gov
.
SUPPLEMENTARY INFORMATION: Although we are not required to do so
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this
Social Security Ruling in accordance with 20 CFR 402.35(b)(1).
Social Security Rulings make available to the public precedential
decisions relating to the Federal old-age, survivors, disability,
supplemental security income, and black lung benefits programs. Social
Security Rulings may be based on case decisions made at all
administrative levels of adjudication, Federal court decisions,
Commissioner's decisions, opinions of the Office of the General
Counsel, and policy interpretations of the law and regulations.
Although Social Security Rulings do not have the same force and
effect as the statute or regulations, they are binding on all
components of the Social Security Administration, in accordance with 20
CFR 402.35(b)(1), and are relied upon as precedents in adjudicating
cases.
If this Social Security Ruling is later superseded, modified, or
rescinded, we will publish a notice in the Federal Register to that
effect.
(Catalog of Federal Domestic Assistance, Program Nos. 96.001 Social
Security--Disability Insurance; 96.006 Supplemental Security Income)
Dated: October 8, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.
Policy Interpretation Ruling
Titles II and XVI: Evaluating Cases Involving Reflex Sympathetic
Dystrophy Syndrome/Complex Regional Pain Syndrome
Purpose: To explain the policies of the Social Security
Administration for developing and evaluating title II and title XVI
claims for disability on the basis of Reflex Sympathetic Dystrophy
Syndrome (RSDS), also frequently known as Complex Regional Pain
Syndrome, Type I (CRPS). These terms are synonymous and are used to
describe a unique clinical syndrome that may develop following trauma.
This syndrome is characterized by complaints of intense pain and
typically includes signs of autonomic dysfunction.
Citations (Authority): Sections 216(i), 223(d), 1614(a)(3),
1614(a)(4) and 1614(c) of the Social Security Act (the Act), as
amended; Regulations No. 4, subpart P, sections 404.1502, 404.1505,
404.1508-404.1509, 404.1511-404.1513, 404.1520, 404.1520a, 404.1521,
404.1523, 404.1526-404.1530, 404.1545-404.1546, 404.1560-404.1569a; and
404.1593-404.1594 and appendix 1; and Regulations No. 16, subpart I,
sections 416.902, 416.905, 416.906, 416.908-416.909, 416.911-416.913,
416.920, 416.920a, 416.921, 416.923, 416.924, 416.924a-416.924c,
416.925, 416.926, 416.926a, 416.927-416.930, 416.945-416.946, 416.960-
416.969a, 416.987, and 416.993-416.994a.
Introduction: RSDS/CRPS are terms used to describe a constellation
of symptoms and signs that may occur following an injury to bone or
soft tissue. The precipitating injury may be so minor that the
individual does not even recall sustaining an injury. Other potential
precipitants suggested by the medical literature include, but are not
limited to, surgical procedures, drug exposure, stroke with hemiplegia,
and cervical spondylosis.
Policy Interpretation
What Is RSDS/CRPS?
RSDS/CRPS is a chronic pain syndrome most often resulting from
trauma to a single extremity. It can also result from diseases,
surgery, or injury affecting other parts of the body. Even a minor
injury can trigger RSDS/CRPS. The most common acute clinical
manifestations include complaints of intense pain and findings
indicative of autonomic dysfunction at the site of the precipitating
trauma. Later, spontaneously occurring pain may be associated with
abnormalities in the affected region involving the skin, subcutaneous
tissue, and bone. It is characteristic of this syndrome that the degree
of pain reported is out of proportion to the severity of the injury
sustained by the individual. When left untreated, the signs and
symptoms of the disorder may worsen over time.
Although the pathogenesis of this disorder (the precipitating
mechanism(s) of the signs and symptoms characteristic of RSDS/CRPS) has
not been defined, dysfunction of the sympathetic nervous system has
been strongly implicated.
The sympathetic nervous system regulates the body's involuntary
physiological responses to stressful stimuli. Sympathetic stimulation
results in physiological changes that prepare the body to respond to a
stressful stimulus by ``fight or flight.'' The so-called ``fight or
flight'' response is characterized by constriction of peripheral
vasculature (blood vessels supplying skin), increase in heart rate and
sweating, dilatation of bronchial tubes, dilatation of pupils, increase
in level of alertness, and constriction of sphincter musculature.
Abnormal sympathetic nervous system function may produce
inappropriate or exaggerated neural signals that may be misinterpreted
as pain. In addition, abnormal sympathetic stimulation may produce
changes in blood vessels, skin, musculature and bone. Early recognition
of the syndrome and prompt treatment, ideally within 3 months of the
first symptoms, provides the greatest opportunity for effective
recovery.
How Does RSDS/CRPS Typically Present?
RSDS/CRPS patients typically report persistent, burning, aching or
searing pain that is initially localized to the site of the injury. The
involved area usually has increased sensitivity to touch. The degree of
reported pain is often out of proportion to the severity of the
precipitating injury. Without appropriate treatment, the pain and
associated atrophic skin and bone changes may spread to involve an
entire limb. Cases have been reported to progress and spread to other
limbs, or to remote parts of the body.
Clinical studies have demonstrated that when treatment is delayed,
the signs and symptoms may progress and spread, resulting in long-term
and even permanent physical and psychological problems. Some
investigators have found that the signs and symptoms of
[[Page 59973]]
RSDS/CRPS persist longer than 6 months in 50 percent of cases, and may
last for years in cases where treatment is not successful.
What Are the Diagnostic Criteria for RSDS/CRPS?
A diagnosis of RSDS/CRPS requires the presence of complaints of
persistent, intense pain that results in impaired mobility of the
affected region. The complaints of pain are associated with:
[sbull] Swelling;
[sbull] Autonomic instability--seen as changes in skin color or
texture, changes in sweating (decreased or excessive sweating), skin
temperature changes, or abnormal pilomotor erection (gooseflesh);
[sbull] Abnormal hair or nail growth (growth can be either too slow
or too fast);
[sbull] Osteoporosis; or
[sbull] Involuntary movements of the affected region of the initial
injury.
Progression of the clinical disorder is marked by worsening of a
previously identified finding, or the manifestation of additional
abnormal changes in the skin, nails, muscles, joints, ligaments, and
bones of the affected region. Clinical progression does not necessarily
correlate with specific timeframes. Efficacy of treatment must be
judged on the basis of the treatment's effect on the pain and whether
or not progressive changes continue in the tissues of the affected
region.
Reported pain at the site of the injury may be followed by
complaints of muscle pain, joint stiffness, restricted mobility, or
abnormal hair and nail growth in the affected region. Further, signs of
autonomic instability (changes in the color or temperature of the skin
and frequent appearance of goose bumps) may develop in the affected
region. Osteoporosis may be noted by appropriate medically acceptable
imaging techniques. Complaints of pain can further intensify, and can
be reported to spread to involve other extremities. Muscle atrophy and
contractures can also develop. Persistent clinical progression
resulting in muscle atrophy and contractures, or progression of
complaints of pain to include other extremities or regions, in spite of
appropriate diagnosis and treatment, hallmark a poor prognosis.
How Is RSDS/CRPS Treated?
Patient education and activity programs designed to increase limb
mobility and promote use of the extremity or affected region during
activities of daily living are considered the most important treatments
for RSDS/CRPS. The medical literature has demonstrated that individuals
affected by RSDS/CRPS have a better prognosis when they receive an
early diagnosis and mobility is immediately encouraged. In some
patients, it is necessary to inject a long-acting anesthetic to block
sympathetic activity and reduce pain to allow the individual to
increase the mobility of the affected region. Various analgesics,
including narcotics and neurostimulators, may be used to minimize pain
and promote the individual's ability to tolerate greater mobility.
A mental evaluation may be requested by treating or other medical
sources to determine if any undiagnosed psychiatric disease is present
that could potentially contribute to a reduced pain tolerance. It is
important to recognize that such evaluations are not based on concern
that RSDS/CRPS findings are imaginary or etiologically linked to
psychiatric disease. The behavioral and cognitive effects of the
medications used to treat pain need to be thoroughly considered in the
evaluation of this syndrome.
Other types of medications may also be used to reduce pain. Anti-
inflammatory preparations, psychotropic medications (for example,
antidepressants), certain antiepileptic drugs, muscle relaxants, and
drugs that produce generalized reduction in sympathetic outflow may be
tried in an effort to reduce the signs and symptoms associated with
RSDS/CRPS and improve the mobility of the affected region.
Patients who are noted to have a good response to local sympathetic
blocks may be considered candidates for surgical sympathectomy. This
procedure permanently disrupts the sympathetic innervation of the
affected region. It involves destroying a sympathetic ganglion and must
be performed by a physician who is an expert in this technique. This
procedure is not without risk of post-surgical complications.
What Is a Medically Determinable Impairment?
Sections 216(i) and 1614(a)(3) of the Act define ``disability'' \1\
as the inability to engage in any substantial gainful activity by
reason of any medically determinable physical or mental impairment (or
combination of impairments) which can be expected to result in death or
which has lasted or can be expected to last for a continuous period of
not less than 12 months.\2\
---------------------------------------------------------------------------
\1\ Except for statutory blindness.
\2\ For individuals under age 18 claiming benefits under title
XVI, disability will be established if the individual is suffering
from a medically determinable physical or mental impairment (or
combination of impairments) that results in ``marked and severe
functional limitations.'' See section 1614(a)(3)(C) of the Act and
20 CFR 416.906. However, for clarity, the following discussions
refer only to claims of individuals claiming disability benefits
under title II and individuals age 18 or older claiming disability
benefits under title XVI. It should be understood that references in
this Ruling to the ability to do substantial gainful activity,
``RFC,'' and other terms and rules that are applicable only to title
II disability claims and title XVI disability claims of individuals
age 18 or older are also intended to refer to appropriate terms and
rules applicable in determining disability for individuals under age
18 under title XVI.
---------------------------------------------------------------------------
Sections 223(d)(3) and 1614(a)(3)(D) of the Act, and 20 CFR
404.1508 and 416.908, require that impairment result from anatomical,
physiological, or psychological abnormalities that can be shown by
medically acceptable clinical and laboratory diagnostic techniques. The
Act and regulations further require that impairment be established by
medical evidence that consists of signs, symptoms, and laboratory
findings, and not only by an individual's statement of symptoms.
How Is RSDS/CRPS Identified as a Medically Determinable Impairment?
RSDS/CRPS constitutes a medically determinable impairment when it
is documented by appropriate medical signs, symptoms, and laboratory
findings, as discussed above. RSDS/CRPS may be the basis for a finding
of ``disability.'' Disability may not be established on the basis of an
individual's statement of symptoms alone.
For purposes of Social Security disability evaluation, RSDS/CRPS
can be established in the presence of persistent complaints of pain
that are typically out of proportion to the severity of any documented
precipitant and one or more of the following clinically documented
signs in the affected region at any time following the documented
precipitant:
[sbull] Swelling;
[sbull] Autonomic instability--seen as changes in skin color or
texture, changes in sweating (decreased or excessive sweating), changes
in skin temperature, and abnormal pilomotor erection (gooseflesh);
[sbull] Abnormal hair or nail growth (growth can be either too slow
or too fast);
[sbull] Osteoporosis; or
[sbull] Involuntary movements of the affected region of the initial
injury.
When longitudinal treatment records document persistent limiting
pain in an area where one or more of these abnormal signs has been
documented at
[[Page 59974]]
some point in time since the date of the precipitating injury,
disability adjudicators can reliably determine that RSDS/CRPS is
present and constitutes a medically determinable impairment. It may be
noted in the treatment records that these signs are not present
continuously, or the signs may be present at one examination and not
appear at another. Transient findings are characteristic of RSDS/CRPS,
and do not affect a finding that a medically determinable impairment is
present.
How Is Medical Evidence of the Impairment Documented?
In cases involving RSDS/CRPS, the documentation of medical signs or
laboratory findings at some point in time in the clinical record since
the date of the precipitating injury is critical in establishing the
presence of a medically determinable impairment. In cases in which
RSDS/CRPS is alleged, longitudinal clinical records reflecting ongoing
medical evaluation and treatment from the individual's medical sources,
especially treating sources, are extremely helpful in documenting the
presence of any medical signs, symptoms and laboratory findings.
Generally, evidence for the 12-month period preceding the month of
application should be obtained, unless there is reason to believe that
development of an earlier period is necessary, the alleged onset of
disability is less than 12 months before the date of the application,
or a fully favorable determination can be made with less evidence.
If the adjudicator finds that the evidence is inadequate to
determine whether the individual is disabled, he or she must first
recontact the individual's treating or other medical source(s) to
determine whether the additional information needed is readily
available, in accordance with 20 CFR 404.1512 and 416.912. Only after
the adjudicator determines that the information is not readily
available from the individual's health care provider(s), or that the
necessary information or clarification cannot be sought from the
individual's health care provider(s), should the adjudicator proceed to
arrange for a consultative examination(s) in accordance with 20 CFR
404.1519a and 416.919a. The type of consultative examination(s)
purchased will depend on the nature of the individual's symptoms and
the extent of the evidence already in the case record.
It should be noted that conflicting evidence in the medical record
is not unusual in cases of RSDS due to the transitory nature of its
objective findings and the complicated diagnostic process involved.
Clarification of any such conflicts in the medical evidence should be
sought first from the individual's treating or other medical sources.
Medical opinions from treating sources about the nature and
severity of an individual's impairment(s) are entitled to deference and
may be entitled to controlling weight. If we find that a treating
source's medical opinion on the issue of the nature and severity of an
individual's impairment(s) is well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent
with the other substantial evidence in the case record, the adjudicator
will give it controlling weight. (See SSR 96-2p, ``Titles II and XVI:
Giving Controlling Weight to Treating Source Medical Opinions,'' and
SSR 96-5p, ``Titles II and XVI: Medical Source Opinions on Issues
Reserved to the Commissioner.'') \3\
---------------------------------------------------------------------------
\3\ A medical source opinion that an individual is ``disabled''
or ``unable to work,'' has an impairment(s) that meets or equals the
requirements of a listing, has a particular residual functional
capacity (RFC), that concerns whether an individual's RFC prevents
him or her from doing past relevant work, or that concerns the
application of vocational factors, is an opinion on an issue
reserved to the Commissioner. Every such opinion must still be
considered in adjudicating a disability claim; however, the
adjudicator will not give any special significance to such an
opinion because of its source. See SSR 96-5p for an additional
discussion of this issue.
---------------------------------------------------------------------------
How Is the Duration and Severity of RSDS/CRPS Established?
The signs and symptoms of RSDS/CRPS may remain stable over time,
improve, or worsen. Documentation should, whenever appropriate, include
a longitudinal clinical record containing detailed medical
observations, treatment, the individual's response to treatment,
complications of treatment, and a detailed description of how the
impairment limits the individual's ability to function and perform or
sustain work activity over time.
Chronic pain and many of the medications prescribed to treat it may
affect an individual's ability to maintain attention and concentration,
as well as adversely affect his or her cognition, mood, and behavior,
and may even reduce motor reaction times. These factors can interfere
with an individual's ability to sustain work activity over time, or
preclude sustained work activity altogether. When evaluating duration
and severity, as well as when evaluating RFC, the effects of chronic
pain and the use of pain medications must be carefully considered.
When the alleged onset of disability secondary to RSDS/CRPS
occurred less than 12 months before adjudication, the adjudicator must
evaluate the available medical evidence and project the degree of
impairment severity that is likely to exist at the end of 12 months.
Information about treatment and response to treatment, as well as any
medical source opinions about the individual's prognosis at the end of
12 months, are helpful in deciding whether the medically determinable
impairment is expected to be of disabling severity for at least 12
consecutive months.
In those cases in which an individual is found disabled based on
RSDS/CRPS, but medical improvement is anticipated, the adjudicator
should schedule an appropriate medical reexamination date consistent
with the information indicating the likelihood of medical improvement.
How Is RSDS/CRPS Evaluated?
Claims in which the individual alleges RSDS/CRPS are adjudicated
using the sequential evaluation process, just as for any other
impairment. Because finding that RSDS/CRPS is a medically determinable
impairment requires the presence of chronic pain and one or more
clinically documented signs in the affected region, the adjudicator can
reliably find that pain is an expected symptom in this disorder. Other
symptoms, including such things as extreme sensitivity to touch or
pressure, or abnormal sensations of heat or cold, can also be
associated with this disorder. Given that a variety of symptoms can be
associated with RSDS/CRPS, once the disorder has been established as a
medically determinable impairment, the adjudicator must evaluate the
intensity, persistence, and limiting effects of the individual's
symptoms to determine the extent to which the symptoms limit the
individual's ability to do basic work activities. For this purpose,
whenever the individual's statements about the intensity, persistence,
or functionally limiting effects of pain or other symptoms are not
substantiated by objective medical evidence, the adjudicator must make
a finding on the credibility of the individual's statements based on a
consideration of the entire case record. This includes the medical
signs and laboratory findings, the individual's own statements about
the symptoms, any statements and other information provided by treating
or examining physicians or psychologists and other persons about the
symptoms and how they affect the individual, and any other relevant
evidence in the case record. Although symptoms alone
[[Page 59975]]
cannot be the basis for finding a medically determinable impairment,
once the existence of a medically determinable impairment has been
established, an individual's symptoms and the effect(s) of those
symptoms on the individual's ability to function must be considered
both in determining impairment severity and in assessing the
individual's residual functional capacity (RFC), as appropriate. If the
adjudicator finds that pain or other symptoms cause a limitation or
restriction having more than a minimal effect on an individual's
ability to perform basic work activities, a ``severe'' impairment must
be found to exist. See SSR 96-3p, ``Titles II and XVI: Considering
Allegations of Pain and Other Symptoms in Determining Whether a
Medically Determinable Impairment is Severe'' and SSR 96-7p, ``Titles
II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the
Credibility of an Individual's Statements.''
Proceeding with the sequential evaluation process, when an
individual is found to have a medically determinable impairment that is
``severe,'' the adjudicator must next consider whether the individual's
impairment(s) meets or equals the requirements of the Listing of
Impairments contained in appendix 1, subpart P of 20 CFR part 404.
Since RSDS/CRPS is not a listed impairment, an individual with RSDS/
CRPS alone cannot be found to have an impairment that meets the
requirements of a listed impairment. However, the specific findings in
each case should be compared to any pertinent listing to determine
whether medical equivalence may exist.\4\ Psychological manifestations
related to RSDS/CRPS should be evaluated under the mental disorders
listings, and consideration should be given as to whether the
individual's impairment(s) meets or equals the severity of a mental
listing.
---------------------------------------------------------------------------
\4\ In evaluating title XVI claims for disability benefits for
individuals under age 18, consideration must be given to the
possibility of finding functional equivalence based on the
individual's impairment and related symptoms and their effects on
whether the individual's impairment(s) results in marked and severe
functional limitations.
---------------------------------------------------------------------------
For those cases in which the individual's impairment(s) does not
meet or equal the listings, an assessment of RFC must be made, and
adjudication must proceed to the fourth and, if necessary, the fifth
step of the sequential evaluation process. Again, in determining RFC,
all of the individual's symptoms must be considered in deciding how
such symptoms may affect functional capacities. Careful consideration
must be given to the effects of pain and its treatment on an
individual's capacity to do sustained work-related physical and mental
activities in a work setting on a regular and continuing basis. See SSR
96-7p, ``Titles II and XVI: Evaluation of Symptoms in Disability
Claims: Assessing the Credibility of an Individual's Statements'' and
SSR 96-8p, ``Titles II and XVI: ``Assessing Residual Functional
Capacity in Initial Claims.''
Opinions from an individual's medical sources, especially treating
sources, concerning the effect(s) of RSDS/CRPS on the individual's
ability to function in a sustained manner in performing work
activities, or in performing activities of daily living, are important
in enabling adjudicators to draw conclusions about the severity of the
impairment(s) and the individual's RFC. In this regard, any information
a medical source is able to provide contrasting the individual's
medical condition(s) and functional capacities since the alleged onset
of RSDS/CRPS with the individual's status prior to the onset of RSDS/
CRPS is helpful to the adjudicator in evaluating the individual's
impairment(s) and the resulting functional consequences.
In cases involving RSDS/CRPS, third-party information, including
evidence from medical practitioners who have provided services to the
individual, and who may or may not be ``acceptable medical sources,''
is often critical in deciding the individual's credibility. Information
other than an individual's allegations and reports from the
individual's treating sources helps to assess an individual's ability
to function on a day-to-day basis and helps to depict the individual's
capacities over a period of time, thus serving to establish a
longitudinal picture of the individual's status. Such evidence
includes, but is not limited to:
[sbull] Information from neighbors, friends, relatives, or clergy;
[sbull] Statements from such individuals as past employers,
rehabilitation counselors, or teachers about the individual's
impairment(s) and the effects of the impairment(s) on the individual's
functioning in the work place, rehabilitation facility, or educational
institution;
[sbull] Statements from other practitioners with knowledge of the
individual, e.g., nurse-practitioners, physicians' assistants,
naturopaths, therapists, social workers, and chiropractors;
[sbull] Statements from other sources with knowledge of the
individual's ability to function in daily activities; and
[sbull] The individual's own record (such as a diary, journal, or
notes) of his or her own impairment(s) and its impact on function over
time.
In accordance with SSR 96-7p, ``Titles II and XVI: Evaluation of
Symptoms In Disability Claims: Assessing The Credibility of An
Individual's Statements,'' when additional information is needed to
assess the credibility of the individual's statements about symptoms
and their effects, the adjudicator must make every reasonable effort to
obtain additional information that could shed light on the credibility
of the individual's statements.
If the adjudicator determines that the individual's impairment(s)
precludes the performance of past relevant work (or if there was no
past relevant work), a finding must be made about the individual's
ability to perform other work. The usual vocational considerations (see
20 CFR 404.1560-404.1569a and 416.960-416.969a) must be followed in
determining the individual's ability to perform other work. See also
SSR 96-8p, ``Titles II and XVI: Assessing Residual Functional Capacity
in Initial Claims.''
Many individuals with RSDS/CRPS are ``younger individuals'' ages 18
through 49 (see 20 CFR 404.1563 and 416.963). Age, education, and work
experience are not usually considered to limit significantly the
ability of individuals under age 50 to make an adjustment to other
work, including unskilled sedentary work.\5\ However, a finding of
``disabled'' is not precluded for those individuals under age 50 who do
not meet all of the criteria of a specific rule and who do not have the
ability to perform a full range of sedentary work. The conclusion about
whether such individuals are disabled will depend primarily on the
nature and extent of their functional limitations or restrictions.
Thus, if it is determined that an individual is able to do less than
the full range of sedentary work, refer to SSR 96-9p, ``Titles II and
XVI: Determining Capability to Do Other Work--Implications of a
Residual Functional Capacity for Less Than a Full Range of Sedentary
Work.'' As explained in that Ruling, whether the individual will be
able to make an adjustment to other work requires
[[Page 59976]]
adjudicative judgment regarding factors such as the type and extent of
the individual's limitations or restrictions and the extent of the
erosion of the occupational base for sedentary work.
---------------------------------------------------------------------------
\5\ However, ``younger individuals'' age 45-49 who are unable to
communicate in English or who are illiterate in English, whose past
work was unskilled (or who had no past relevant work), or who have
no transferable skills, and who are limited to a full range of
sedentary work must be found disabled under rule 201.17 in Table No.
1 of appendix 2, of the Medical-Vocational Guidelines in 20 CFR part
404.
---------------------------------------------------------------------------
Effective Date: This Ruling is effective on the date of its
publication in the Federal Register.
Cross-References: SSR 96-2p, ``Titles II and XVI: Giving
Controlling Weight to Treating Source Medical Opinions,'' SSR 96-3p,
``Titles II and XVI: Considering Allegations of Pain and Other Symptoms
in Determining Whether a Medically Determinable Impairment is Severe,''
SSR 96-5p, ``Titles II and XVI: Medical Source Opinions on Issues
Reserved to the Commissioner,'' SSR 96-7p, ``Titles II and XVI:
Evaluation of Symptoms in Disability Claims: Assessing the Credibility
of an Individual's Statements,'' SSR 96-8p, ``Titles II and XVI:
Assessing Residual Functional Capacity in Initial Claims,'' and SSR 96-
9p, ``Titles II and XVI: Determining Capability to Do Other Work--
Implications of a Residual Functional Capacity for Less Than a Full
Range of Sedentary Work.''
[FR Doc. 03-26332 Filed 10-17-03; 8:45 am]
BILLING CODE 4910-02-U