[Federal Register Volume 60, Number 175 (Monday, September 11, 1995)]
[Proposed Rules]
[Pages 47121-47126]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-22103]



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RAILROAD RETIREMENT BOARD

20 CFR Part 220

RIN 3220-AA99


Determining Disability

AGENCY: Railroad Retirement Board.

ACTION: Proposed rule.

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SUMMARY: The Board proposes to update its regulations to reflect a 
change in how it evaluates pain and other subjective symptoms when 
determining if an individual is disabled from all regular employment. 
Other changes are proposed to reflect changes in law and procedure.

DATES: Comments must be received by November 13, 1995.

ADDRESSES: Secretary to the Board, Railroad Retirement Board, 844 North 
Rush Street, Chicago, Illinois 60611-2092.

FOR FURTHER INFORMATION CONTACT: Thomas W. Sadler, Assistant General 
Counsel, Railroad Retirement Board, 844 North Rush Street, Chicago, 
Illinois 60611, (312) 751-4513, TDD (312) 751-4701.

SUPPLEMENTARY INFORMATION: Courts have consistently held that 
disability for all regular employment under section 2(a)(1)(v) of the 
Railroad Retirement Act (45 U.S.C. 231a(a)(1)(v)) is synonymous with 
the inability to perform any substantial gainful activity under section 
223(d) of the Social Security Act (42 U.S.C. 423(d)). Therefore, the 
Board has generally patterned its regulations dealing with the 
adjudication of claims for disability based upon the inability to 
engage in all regular employment (20 CFR Part 220) on regulations 
promulgated by the Department of Health and Human Services, Social 
Security Administration (20 CFR Part 404, Subpart P). On November 14, 
1991, the Social Security Administration published a final rule (56 FR 
57928) expanding its regulations pertaining to how it evaluates 
symptoms, including pain, in its disability adjudication. The Board has 
generally followed these regulations in adjudication of claims for 
disability based on inability to engage in regular employment and now 
proposes to amend its regulations to conform thereto.
    Proposed Sec. 220.100(f) explains how a symptom, such as pain, is 
considered when it appears as a criterion in the Listing of Impairments 
contained in Appendix 1 of this part. Appendix 1 contains medical 
criteria for finding a person disabled on medical factors alone without 
consideration of the person's age, education, and work experience.
    The addition of proposed Sec. 220.100(g) insures that the Listing 
of Impairments contained in Appendix 1 will at all times conform to 
Appendix 1 of Subpart P, 20 CFR, Part 404, of the Social Security 
Adminitration's disability regulations unless specifically indicated 
otherwise by regulation under this part.
    Section 220.112(a) is proposed to be revised by eliminating the 
reference to remarried widow(ers) and surviving divorced spouses. 
Section 5103 of Public Law 101-508 revised the standard of disability 
for these groups of beneficiaries to require the consideration of other 
than medical factors, such as age, education, and experience, in 
determining disability for all substantial gainful activity for these 
groups. Prior to the amendment, only medical factors were required to 
be used in a disability determination for these beneficiaries.
    The proposed rule completely revises Sec. 220.114 to parallel the 
Social Security regulation dealing with the same subject. See 
Sec. 404.1529 of this chapter. Proposed Sec. 220.114 will provide 
guidance on the evaluation of symptoms, including pain. The proposed 
regulation conforms to the Board's current procedures and applicable 
court decisions on the evaluation of symptoms, especially pain, in 
making disability determinations.
    Paragraph (a) of proposed Sec. 220.114 is a general statement of 
how symptoms, such as pain, are considered in determining disability. 
It explains that the Board will consider a claimant's symptoms along 
with other objective medical evidence and other evidence relating to a 
claimant's condition.
    Paragraph (b) of proposed Sec. 220.114 explains that the Board will 
not find that pain will affect an individual's ability to do basic work 
activities unless the claimant first establishes that he or she has a 
medically determinable physical or mental impairment, supported by 
medical signs and laboratory findings, to which the allegation of pain 
can reasonably be related.
    Paragraph (c) of proposed Sec. 220.114 provides that when a 
symptom, such as pain, is established, the Board must then evaluate the 
intensity and persistence of the symptom with respect to how it limits 
the claimant's capacity for work. In making this evaluation the Board 
considers all available evidence, including the claimant's medical 
history, statements from the claimant and his treating physician, and 
statements from others who have knowledge of the claimant's situation.
    Paragraph (d) of proposed Sec. 220.114 explains how symptoms, such 
as pain, are evaluated in the sequential evaluation process required in 
disability adjudication.
    The proposed rule would revise Sec. 220.120 to explain that in 
determining the claimant's residual functional capacity the Board 
considers the claimant's symptoms, such as pain, and that such pain or 
other symptoms may limit the claimant's residual functional capacity 
beyond what can be determined from anatomical or physiological 
abnormalities taken alone. Consistent with the revision of section 
220.120, proposed new Sec. 220.135 explains that a claimant's symptoms, 
such as pain, may cause both exertional and nonexertional limitations. 
This proposed new section defines these terms. Only when the claimant's 
impairments and related symptoms impose solely exertional impairments 
do the rules set forth in Appendix 2 of this part direct a conclusion.
    Proposed Sec. 220.134 does for Appendix 2 of this part what the 
proposed amendment to Sec. 220.100(g) does for Appendix 1 and insures 
that Appendix 2 will be consistent with the comparable appendix in the 
regulations under the Social Security Act. Appendix 2 contains the 
medical vocational guidelines or ``grids''. The grids direct a finding 
of disabled or not disabled based on specified limitations combined 
with the individual's age, education, and work experience. Appendix 2 
was developed by the Social Security Administration after an extensive 
administrative rule-making procedure. The Board has adopted the 
Administration's Appendix 2 in its disability adjudication. This 
amendment will insure that the Board's Appendix 2 automatically remains 
in conformance with that of the Social Security Administration except 
where otherwise stated by this regulation.
    Finally, the proposed amendment to Sec. 200.00 of Appendix 2 
conforms that section to the revised Sec. 220.120.
    The Board, with the agreement of the Office of Management and 
Budget, has determined that this is not a significant regulatory action 
under Executive Order 12866; therefore, no regulatory impact analysis 
is required. There are no information collections associated with this 
rule.

List of Subjects in 20 CFR Part 220

    Disability benefits, Railroad employees, Railroad retirement.

    For the reasons set out in the preamble, Part 220 of Title 20 of 
the 

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Code of Federal Regulations is proposed to be amended as follows:

PART 220--DETERMINING DISABILITY

    1. The authority for Part 220 continues to read as follows:

    Authority: 45 U.S.C. 231a; 45 U.S.C. 231f.

    2. Section 220.110 is amended by adding paragraphs (f) and (g) to 
read as follows:


Sec. 220.110  Listing of impairments in Appendix 1 of this part.

* * * * *
    (f) Symptoms as criteria of listed impairment(s). Some listed 
impairment(s) include symptoms usually associated with those 
impairment(s) as criteria. Generally, when a symptom is one of the 
criteria in a listed impairment, it is only necessary that the symptom 
be present in combination with the other criteria. It is not necessary, 
unless the listing specifically states otherwise, to provide 
information about the intensity, persistence or limiting effects of the 
symptom as long as all other findings required by the specific listing 
are present.
    (g) The Listing of Impairments found in Appendix 1 of this part is 
intended to be identical to the list promulgated by the Social Security 
Administration in Appendix 1 of Subpart P, 20 CFR Part 404. In addition 
to Appendix 1 of this part a claimant should also consult Appendix 1 of 
20 CFR, Subpart P, Part 404.


Sec. 220.112  [Amended]

    3. The penultimate sentence of Sec. 220.112(a) is amended by 
removing the words ``Except in cases of remarried widows, widowers, and 
surviving divorced spouses, the'' and adding the word ``The'' to begin 
that sentence.


Sec. 220.114  [Amended]

    4. Section 220.114 is revised to read as follows:


Sec. 220.114  Evaluation of symptoms, including pain.

    (a) General. In determining whether the claimant is disabled, the 
Board considers all of the claimant's symptoms, including pain, and the 
extent to which the claimant's symptoms can reasonably be accepted as 
consistent with the objective medical evidence and other evidence. By 
objective medical evidence, the Board means medical signs and 
laboratory findings as defined in Sec. 220.113 (b) and (c) of this 
part. By other evidence, the Board means the kinds of evidence 
described in Secs. 220.45 and 220.46 of this part. These include 
statements or reports from the claimant, the claimant's treating or 
examining physician or psychologist, and others about the claimant's 
medical history, diagnosis, prescribed treatment, daily activities, 
efforts to work, and any other evidence showing how the claimant's 
impairment(s) and any related symptoms affect the claimant's ability to 
work. The Board will consider all of the claimant's statements about 
his or her symptoms, such as pain, and any description by the claimant, 
the claimant's physician or psychologist, or other persons about how 
the symptoms affect the claimant's activities of daily living and 
ability to work. However, statements about the claimant's pain or other 
symptoms will not alone establish that the claimant is disabled; there 
must be medical signs and laboratory findings which show that the 
claimant has a medical impairment(s) which could reasonably be expected 
to produce the pain or other symptoms alleged and which, when 
considered with all of the other evidence (including statements about 
the intensity and persistence of the claimant's pain or other symptoms 
which may reasonably be accepted as consistent with the medical signs 
and laboratory findings), would lead to a conclusion that the claimant 
is disabled. In evaluating the intensity and persistence of the 
claimant's symptoms, including pain, the Board will consider all of the 
available evidence, including the claimant's medical history, the 
medical signs and laboratory findings and statements about how the 
claimant's symptoms affect the claimant. (Section 220.112 of this part 
explains how the Board considers opinions of the claimant's treating 
source and other medical opinions on the existence and severity of the 
claimant's symptoms, such as pain.) The Board will then determine the 
extent to which the claimant's alleged functional limitations and 
restrictions due to pain or other symptoms can reasonably be accepted 
as consistent with the medical signs and laboratory findings and other 
evidence to decide how the claimant's symptoms affect the claimant's 
ability to work.
    (b) Need for medically determinable impairment that could 
reasonably be expected to produce symptoms, such as pain. The 
claimant's symptoms, such as pain, fatigue, shortness of breath, 
weakness, or nervousness will not be found to affect the claimant's 
ability to do basic work activities unless medical signs or laboratory 
findings show that a medically determinable impairment(s) is present. 
Medical signs and laboratory findings, established by medically 
acceptable clinical or laboratory diagnostic techniques, must show the 
existence of a medical impairment(s) which results from anatomical, 
physiological, or psychological abnormalities and which could 
reasonably be expected to produce the pain or other symptoms alleged. 
The finding that the claimant's impairment(s) could reasonably be 
expected to produce the claimant's pain or other symptoms does not 
involve a determination as to the intensity, persistence, or 
functionally limiting effects of the claimant's symptoms. The Board 
will develop evidence regarding the possibility of a medically 
determinable mental impairment when the Board has information to 
suggest that such an impairment exists, and the claimant alleges pain 
or other symptoms but the medical signs and laboratory findings do not 
substantiate any physical impairment(s) capable of producing the pain 
or other symptoms.
    (c) Evaluating the intensity and persistence of symptoms, such as 
pain, and determining the extent to which the claimant's symptoms limit 
his or her capacity for work. (1) General. When the medical signs or 
laboratory findings show that the claimant has a medically determinable 
impairment(s) that could reasonably be expected to produce the 
claimant's symptoms, such as pain, the Board must then evaluate the 
intensity and persistence of the claimant's symptoms so that it can 
determine how the claimant's symptoms limit the claimant's capacity for 
work. In evaluating the intensity and persistence of the claimant's 
symptoms the Board considers all of the available evidence including 
the claimant's medical history, the medical signs and laboratory 
findings, and statements from the claimant, the claimant's treating or 
examining physician or psychologist, or other persons about how the 
claimant's symptoms affect the claimant. The Board also considers the 
medical opinions of the claimant's treating source and other medical 
opinions as explained in Sec. 220.112 of this part. Paragraphs (c)(2) 
through (c)(4) of this section explain further how the Board evaluates 
the intensity and persistence of the claimant's symptoms and how it 
determines the extent to which the claimant's symptoms limit the 
claimant's capacity for work, when the medical signs or laboratory 
findings show the claimant has a medically determinable impairment(s) 
that could reasonably be expected to produce the claimant's symptoms, 
such as pain.
    (2) Consideration of objective medical evidence. Objective medical 
evidence is evidence obtained from the application 

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of medically acceptable clinical and laboratory diagnostic techniques, 
such as evidence of reduced joint motion, muscle spasm, sensory deficit 
or motor disruption. Objective medical evidence of this type is a 
useful indicator to assist the Board in making reasonable conclusions 
about the intensity and persistence of the claimant's symptoms and the 
effect those symptoms, such as pain, may have on the claimant's ability 
to work. The Board must always attempt to obtain objective medical 
evidence and, when it is obtained, will consider it in reaching a 
conclusion as to whether the claimant is disabled. However, the Board 
will not reject the claimant's statements about the intensity and 
persistence of the claimant's pain or other symptoms or about the 
effect the claimant's symptoms have on the claimant's ability to work 
solely because the available objective medical evidence does not 
substantiate the claimant's statements.
    (3) Consideration of other evidence. Since symptoms sometimes 
suggest a greater severity of impairment than can be shown by objective 
medical evidence alone, the Board will carefully consider any other 
information the claimant may submit about his or her symptoms. The 
information that the claimant, the claimant's treating physician or 
psychologist, or other persons provide about the claimant's pain or 
other symptoms (e.g., what may precipitate or aggravate the claimant's 
symptoms, what medications, treatments or other methods he or she uses 
to alleviate them, and how the symptoms may affect his or her pattern 
of daily living) is also an important indicator of the intensity and 
persistence of the claimant's symptoms. Because symptoms, such as pain, 
are subjective and difficult to quantify, any symptom-related 
functional limitations and restrictions which the claimant, the 
claimant's treating or examining physician or psychologist, or other 
persons report, which can reasonably be accepted as consistent with the 
objective medical evidence and other evidence, will be taken into 
account as explained in paragraph (c)(4) of this section in reaching a 
conclusion as to whether the claimant is disabled. The Board will 
consider all of the evidence presented, including information about the 
claimant's prior work record, the claimant's statements about his or 
her symptoms, evidence submitted by the claimant's treating, examining 
or consulting physician or psychologist, and observations by Board 
employees and other persons. Section 220.112 of this part explains in 
detail how the Board considers and weighs treating source and other 
medical opinions about the nature and severity of the claimant's 
impairment(s) and any related symptoms, such as pain. Factors relevant 
to the claimant's symptoms, such as pain, which the Board will consider 
include:
    (i) The claimant's daily activities;
    (ii) The location, duration, frequency, and intensity of pain or 
other symptoms;
    (iii) Precipitating and aggravating factors;
    (iv) The type, dosage, effectiveness, and side effects of any 
medication the claimant takes or has taken to alleviate pain or other 
symptoms;
    (v) Treatment, other than medication, the claimant receives or has 
received for relief of pain or other symptoms:
    (vi) Any measures the claimant uses or has used to relieve pain or 
other symptoms (e.g., lying flat on the claimant's back, standing for 
15 to 20 minutes every hour, sleeping on a board, etc.); and
    (vii) Other factors concerning the claimant's functional 
limitations and restrictions due to pain or other symptoms.
    (4) How the Board determines the extent to which symptoms, such as 
pain, affect the claimant's capacity to perform basic work activities. 
In determining the extent to which the claimant's symptoms, such as 
pain, affect the claimant's capacity to perform basic work activities, 
the Board considers all of the available evidence described in 
paragraphs (c)(1) through (c)(3) of this section. The Board will 
consider the claimant's statements about the intensity, persistence, 
and limiting effects of the claimant's symptoms, and the Board will 
evaluate the claimant's statements in relation to the objective medical 
evidence and other evidence, in reaching a conclusion as to whether the 
claimant is disabled. The Board will consider whether there are any 
inconsistencies in the evidence and the extent to which there are any 
conflicts between the claimant's statements and the rest of the 
evidence, including the claimant's medical history, the medical signs 
and laboratory findings and statements by the claimant's treating or 
examining physician or psychologist or other persons about how the 
claimant's symptoms affect the claimant. The claimant's symptoms, 
including pain, will be determined to diminish the claimant's capacity 
for basic work activities to the extent that the claimant's alleged 
functional limitations and restrictions due to symptoms, such as pain, 
can reasonably be accepted as consistent with the objective medical 
evidence and other evidence.
    (d) Consideration of symptoms in the disability determination 
process. The Board follows a set order of steps to determine whether 
the claimant is disabled. If the claimant is not doing substantial 
gainful activity, the Board considers the claimant's symptoms, such as 
pain, to evaluate whether the claimant has a severe physical or mental 
impairment(s), and at each of the remaining steps in the process. 
Sections 220.100 and 220.101 of this part explain this process in 
detail. The Board also considers the claimant's symptoms, such as pain, 
at the appropriate steps in the Board's review when the Board considers 
whether the claimant's disability continues. Subpart O of this part 
explains the procedure the Board follows in reviewing whether the 
claimant's disability continues.
    (1) Need to establish a severe medically determinable 
impairment(s). The claimant's symptoms, such as pain, fatigue, 
shortness of breath, weakness, or nervousness, are considered in making 
a determination as to whether the claimant's impairment or combination 
of impairment(s) is severe. (See Sec. 220.100(b)(2) of this part.)
    (2) Decision whether the Listing of Impairments is met. Some listed 
impairment(s) include symptoms, such as pain, as criteria. Section 
220.110(f) of this part explains how the Board considers the claimant's 
symptoms when the claimant's symptoms are included as criteria for a 
listed impairment.
    (3) Decision whether the Listing of Impairments is equaled. If the 
claimant's impairment is not the same as a listed impairment, the Board 
must determine whether the claimant's impairment(s) is medically 
equivalent to a listed impairment. Section 220.111 of this part 
explains how the Board makes this determination. Under Sec. 220.111(b) 
of this part, the Board will consider equivalence based on medical 
evidence only. In considering whether the claimant's symptoms, signs, 
and laboratory findings are medically equal to the symptoms, signs, and 
laboratory findings of a listed impairment, the Board will look to see 
whether the claimant's symptoms, signs, and laboratory findings are at 
least equal in severity to the listed criteria. However, the Board will 
not substitute the claimant's allegations of pain or other symptoms for 
a missing or deficient sign or laboratory finding to raise the severity 
of the claimant's impairment(s) to that of a listed impairment. If the 
symptoms, signs, and laboratory findings of the claimant's 
impairment(s) 

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are equivalent in severity to those of a listed impairment, the Board 
will find the claimant disabled. If the Board determines the claimant's 
impairment(s) is not medically equivalent to a listed impairment, the 
Board will consider the impact of the claimant's symptoms on the 
claimant's residual functional capacity. (See paragraph (d)(4) of this 
section.)
    (4) Impact of symptoms (including pain) on residual functional 
capacity. If the claimant has a medically determinable severe physical 
or mental impairment(s), but the claimant's impairment(s) does not meet 
or equal an impairment listed in Appendix 1 of this part, the Board 
will consider the impact of the claimant's impairment(s) and any 
related symptoms, including pain, on the claimant's residual functional 
capacity. (See Sec. 220.120 of this part.)


Sec. 220.120  [Revised]

    6. Section 220.120 is revised to read as follows:


Sec. 220.120  The claimant's residual functional capacity.

    (a) General. The claimant's impairment(s) and any related symptoms, 
such as pain, may cause physical and mental limitations that affect 
what the claimant can do in a work setting. The claimant's residual 
functional capacity is what the claimant can still do despite the 
claimant's limitations. If the claimant has more than one impairment, 
the Board will consider all of the claimant's impairment(s) of which 
the Board is aware. The Board will consider the claimant's ability to 
meet certain demands of jobs, such as physical demands, mental demands, 
sensory requirements, and other functions, as described in paragraphs 
(b), (c), and (d) of this section. Residual functional capacity is an 
assessment based upon all of the relevant evidence. It may include 
descriptions (even the claimant's own) of limitations that go beyond 
the symptoms, such as pain, that are important in the diagnosis and 
treatment of the claimant's medical condition. Observations by the 
claimant's treating or examining physicians or psychologists, the 
claimant's family, neighbors, friends or other persons, of the 
claimant's limitations, in addition to those observations usually made 
during formal medical examinations, may also be used. These 
descriptions and observations, when used, must be considered along with 
the claimant's medical records to enable the Board to decide to what 
extent the claimant's impairment(s) keeps the claimant from performing 
particular work activities. This assessment of the claimant's remaining 
capacity for work is not a decision on whether the claimant is 
disabled, but is used as the basis for determining the particular types 
of work the claimant may be able to do despite the claimant's 
impairment(s). Then, using the guidelines in Secs. 220.125 through 
220.135 of this part, the claimant's vocational background is 
considered along with the claimant's residual functional capacity in 
arriving at a disability determination or decision. In deciding whether 
the claimant's disability continues or ends, the residual functional 
capacity assessment may also be used to determine whether any medical 
improvement the claimant has experienced is related to the claimant's 
ability to work as discussed in Sec. 220.178 of this part.
    (b) Physical abilities. When the Board assesses the claimant's 
physical abilities, the Board first assesses the nature and extent of 
the claimant's physical limitations and then determines the claimant's 
residual functional capacity for work activity on a regular and 
continuing basis. A limited ability to perform certain physical demands 
of work activity, such as sitting, standing, walking, lifting, 
carrying, pushing, pulling, or other physical functions (including 
manipulative or postural functions, such as reaching, handling, 
stooping or crouching), may reduce the claimant's ability to do past 
work and other work.
    (c) Mental abilities. When the Board assesses the claimant's mental 
abilities, the Board first assesses the nature and extent of the 
claimant's mental limitations and restrictions and then determines the 
claimant's residual functional capacity for work activity on a regular 
and continuing basis. A limited ability to carry out certain mental 
activities, such as limitations in understanding, remembering, and 
carrying out instructions, and in responding appropriately to 
supervision, co-workers, and work pressures in a work setting, may 
reduce the claimant's ability to do past work and other work.
    (d) Other abilities affected by impairment(s). Some medically 
determinable impairment(s), such as skin impairment(s), epilepsy, 
impairment(s) of vision, hearing or other senses, and impairment(s) 
which impose environmental restrictions may cause limitations and 
restrictions which affect other work-related abilities. If the claimant 
has this type of impairment(s), the Board considers any resulting 
limitations and restrictions which may reduce the claimant's ability to 
do past work and other work in deciding the claimant's residual 
functional capacity.
    (e) Total limiting effects. When the claimant has a severe 
impairment(s), but the claimant's symptoms, signs, and laboratory 
findings do not meet or equal those of a listed impairment in Appendix 
1 of this part, the Board will consider the limiting effects of all the 
claimant's impairment(s), even those that are not severe, in 
determining the claimant's residual functional capacity. Pain or other 
symptoms may cause a limitation of function beyond that which can be 
determined on the basis of the anatomical, physiological or 
psychological abnormalities considered alone; e.g., someone with a low 
back disorder may be fully capable of the physical demands consistent 
with those of sustained medium work activity, but another person with 
the same disorder, because of pain, may not be capable of more than the 
physical demands consistent with those of light work activity on a 
sustained basis. In assessing the total limiting effects of the 
claimant's impairment(s) and any related symptoms, the Board will 
consider all of the medical and nonmedical evidence, including the 
information described in Sec. 220.114(c) of this part.


Sec. 220.134  [Amended]

    7. Section 220.134 is amended by adding a new paragraph (d) to read 
as follows:


Sec. 220.134  Medical-Vocational Guidelines in Appendix 2 of this part.

* * * * *
    (d) The medical-vocational guidelines found in Appendix 2 of this 
part are intended to be identical to those promulgated by the Social 
Security Administration in Appendix 2 of Subpart P, 20 CFR Part 404. In 
addition to Appendix 2 of this part a claimant shall also consult 
Appendix 2 of 20 CFR, Subpart P, Part 404.
    8. A new Sec. 220.135 is added to read as follows:


Sec. 220.135  Exertional and nonexertional limitations.

    (a) General. The claimant's impairment(s) and related symptoms, 
such as pain, may cause limitations of function or restrictions which 
limit the claimant's ability to meet certain demands of jobs. These 
limitations may be exertional, nonexertional, or a combination of both. 
Limitations are classified as exertional if they affect the claimant's 
ability to meet the strength demands of jobs. The classification of a 
limitation as exertional is related to the United States Department of 
Labor's 

[[Page 47126]]
classification of jobs by various exertional levels (sedentary, light, 
medium, heavy, and very heavy) in terms of the strength demands for 
sitting, standing, walking, lifting, carrying, pushing, and pulling. 
Sections 220.132 and 220.134 of this part explain how the Board uses 
the classifications of jobs by exertional levels (strength demands) 
which are contained in the Dictionary of Occupational Titles published 
by the Department of Labor, to determine the exertional requirements of 
work which exists in the national economy. Limitations or restrictions 
which affect the claimant's ability to meet the demands of jobs other 
than the strength demands, that is, demands other than sitting, 
standing, walking, lifting, carrying, pushing or pulling, are 
considered nonexertional. Sections 220.100(b)(5) and 220.180(h) of this 
part explain that if the claimant can no longer do the claimant's past 
relevant work because of a severe medically determinable impairment(s), 
the Board must determine whether the claimant's impairment(s), when 
considered along with the claimant's age, education, and work 
experience, prevents the claimant from doing any other work which 
exists in the national economy in order to decide whether the claimant 
is disabled or continues to be disabled. Paragraphs (b), (c), and (d) 
of this section explain how the Board applies the medical-vocational 
guidelines in Appendix 2 of this part in making this determination, 
depending on whether the limitations or restrictions imposed by the 
claimant's impairment(s) and related symptoms, such as pain, are 
exertional, nonexertional, or a combination of both.
    (b) Exertional limitations. When the limitations and restrictions 
imposed by the claimant's impairment(s) and related symptoms, such as 
pain, affect only the claimant's ability to meet the strength demands 
of jobs (sitting, standing, walking, lifting, carrying, pushing, and 
pulling), the Board considers that the claimant has only exertional 
limitations. When the claimant's impairment(s) and related symptoms 
only impose exertional limitations and the claimant's specific 
vocational profile is listed in a rule contained in Appendix 2 of this 
part, the Board will directly apply that rule to decide whether the 
claimant is disabled.
    (c) Nonexertional limitations. (1) When the limitations and 
restrictions imposed by the claimant's impairment(s) and related 
symptoms, such as pain, affect only the claimant's ability to meet the 
demands of jobs other than strength demands, the Board considers that 
the claimant has only nonexertional limitations or restrictions. Some 
examples of nonexertional limitations or restrictions include the 
following:
    (i) Difficulty functioning because of nervousness, anxiety, or 
depression;
    (ii) Difficulty maintaining attention or concentrating;
    (iii) Difficulty understanding or remembering detailed 
instructions;
    (iv) Difficulty in seeing or hearing;
    (v) Difficulty in tolerating some physical feature(s) of certain 
work settings, e.g., inability to tolerate dust or fumes; or
    (vi) Difficulty performing the manipulative or postural functions 
of some work such as reaching, handling, stooping, climbing, crawling, 
or crouching.
    (2) If the claimant's impairment(s) and related symptoms, such as 
pain, only affect the claimant's ability to perform the nonexertional 
aspects of work-related activities, the rules in Appendix 2 of this 
part do not direct factual conclusions of disabled or not disabled. The 
determination as to whether disability exists will be based on the 
principles in the appropriate sections of the regulations, giving 
consideration to the rules for specific case situations in Appendix 2 
of this part.
    (d) Combined exertional and nonexertional limitations. When the 
limitations and restrictions imposed by the claimant's impairment(s) 
and related symptoms, such as pain, affect the claimant's ability to 
meet both the strength demands and demands of jobs other than the 
strength demands, the Board considers that the claimant has a 
combination of exertional and nonexertional limitations or 
restrictions. If the claimant's impairment(s) and related symptoms, 
such as pain, affect the claimant's ability to meet both the strength 
demands and demands of jobs other than the strength demands the Board 
will not directly apply the rules in Appendix 2 of this part unless 
there is a rule that directs a conclusion that the claimant is disabled 
based upon the claimant's strength limitations; otherwise the rules 
provide a framework to guide the Board's decision.


Appendix 2  [Amended]

    9. Appendix 2--Medical-Vocational Guidelines of part 220 is amended 
by revising paragraph (c) of section 200.00 to read as follows:


Sec. 200.00  Introduction. * * *

* * * * *
    (c) In the application of the rules, the individual's residual 
functional capacity (i.e., the maximum degree to which the 
individual retains the capacity for sustained performance of the 
physical-mental requirements of jobs), age, education, and work 
experience must first be determined. When assessing the person's 
residual functional capacity, the Board considers his or her 
symptoms (such as pain), signs, and laboratory findings together 
with other evidence the Board obtains.
* * * * *
    Dated: August 29, 1995.

    By Authority of the Board.
Beatrice Ezerski,
Secretary to the Board.
[FR Doc. 95-22103 Filed 9-8-95; 8:45 am]
BILLING CODE 7905-01-P