[Federal Register Volume 62, Number 186 (Thursday, September 25, 1997)]
[Proposed Rules]
[Pages 50270-50280]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-25366]


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SOCIAL SECURITY ADMINISTRATION

20 CFR Parts 404 and 416

[Regulations Nos. 4 and 16]
RIN 0960-AE56


Federal Old-Age, Survivors, and Disability Insurance and 
Supplemental Security Income for the Aged, Blind, and Disabled; 
Evaluating Opinion Evidence

AGENCY: Social Security Administration.

ACTION: Proposed rules.

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SUMMARY: We propose to revise the Social Security and supplemental 
security income (SSI) regulations about the evaluation of medical 
opinions to clarify how administrative law judges and the Appeals 
Council are to consider opinion evidence from State agency medical and 
psychological consultants, other program physicians and psychologists, 
and medical experts we consult in claims for disability benefits under 
titles II and XVI of the Social Security Act (the Act). We also propose 
to define or clarify several terms used in our regulations and to 
delete other terms.

DATES: To be sure that your comments are considered, we must receive 
them no later than November 24, 1997.

ADDRESSES: Comments should be submitted in writing to the Commissioner 
of Social Security, P.O. Box 1585, Baltimore, MD 21235, sent by telefax 
to (410) 966-2830, sent by E-mail to ``[email protected],'' or 
delivered to the Division of Regulations and Rulings, Social Security 
Administration, 3-B-1 Operations Building, 6401 Security Boulevard, 
Baltimore, MD 21235, between 8:00 a.m. and 4:30 p.m. on regular 
business days. Comments may be inspected during these same hours by 
making arrangements with the contact person shown below.

FOR FURTHER INFORMATION CONTACT: Richard M. Bresnick, Legal Assistant, 
Division of Regulations and Rulings, Social Security Administration, 
6401 Security Boulevard, Baltimore, MD 21235, (410) 965-1758 for 
information about these rules. For information on eligibility or filing 
for benefits, call our national toll-free number, 1-800-772-1213.

SUPPLEMENTARY INFORMATION: The Act provides, in title II, for the 
payment of disability benefits to persons insured under the Act. Title 
II also provides, under certain circumstances, for the payment of 
child's insurance benefits based on disability and widow's and 
widower's insurance benefits for disabled widows, widowers, and 
surviving divorced spouses of insured persons. In addition, the Act 
provides, in title XVI, for SSI payments to persons who are aged, 
blind, or disabled and who have limited income and resources.
    For adults under both the title II and title XVI programs 
(including persons claiming child's insurance benefits based on 
disability under title II), ``disability'' means the inability to 
engage in any substantial gainful activity. For an individual under age 
18 claiming SSI benefits based on

[[Page 50271]]

disability, ``disability'' means that an impairment(s) causes ``marked 
and severe functional limitations.'' Under both title II and title XVI, 
disability must be the result of a medically determinable physical or 
mental impairment(s) that can be expected to result in death or that 
has lasted or can be expected to last for a continuous period of at 
least 12 months.

Explanation of Proposed Revisions

Proposals To Simplify and Clarify Terms

    The current regulations use several terms to refer to sources of 
medical evidence. Regulations Secs. 404.1502 and 416.902, ``General 
definitions and terms for this subpart,'' define the terms ``source of 
record,'' ``medical sources'' (which include ``consultative 
examiners''), and ``treating source.'' These terms are used in various 
sections of the regulations in subpart P of part 404 and subpart I of 
part 416, chiefly Secs. 404.1527 and 416.927, ``Evaluating medical 
opinions about your impairment(s) or disability.'' In addition, 
Secs. 404.1519 and 416.919 use the phrase ``a treating physician or 
psychologist, another source of record, or an independent source.'' 
Regulations Secs. 404.1527 and 416.927 also employ the terms 
``nontreating source'' and ``nonexamining source.''
    In paragraph (a) of Secs. 404.1513 and 416.913 of our regulations, 
we say that we need reports about the individual's impairments from 
``acceptable medical sources'' and we identify the sources who are 
acceptable medical sources. We need various terms for acceptable 
medical sources in only three, specific instances: (1) When we explain 
the preference we give to obtaining evidence from treating sources, (2) 
when we explain the preference we give to treating sources to perform 
consultative examinations, and (3) in our rules for weighing opinions 
from acceptable medical sources. In the first two cases, the only 
definition that is needed is the definition of a ``treating source.'' 
In the last case, relevant distinctions are needed between treating 
sources, nontreating sources (i.e., acceptable medical sources, such as 
some consultative examiners, who have examined an individual but not 
provided treatment), and nonexamining sources (i.e., acceptable medical 
sources who have provided opinion evidence but who have not treated or 
examined the individual).
    Therefore, we propose to simplify and clarify the terms we use to 
describe various acceptable medical sources of evidence, including 
medical opinion evidence (i.e., opinions on the nature and severity of 
an individual's impairment(s)--see current Secs. 404.1527(a)(2) and 
416.927(a)(2)) and other opinions (e.g., opinions on issues reserved to 
the Commissioner--see current Secs. 404.1527(e) and 416.927(e)), by 
using only four terms: Treating source, nontreating source, 
nonexamining source, and an overall term, ``acceptable medical 
source,'' which would include all three types of sources. These 
proposals would not change our current policy, but are only intended to 
clarify our intent.
    To do this, we propose to define the term ``acceptable medical 
source'' in Secs. 404.1502 and 416.902. This is a term we have used for 
many years in Secs. 404.1513(a) and 416.913(a). We also propose to 
redefine the term ``medical sources'' to mean acceptable medical 
sources, or other health care providers who are not ``acceptable 
medical sources,'' to clarify our intent in certain regulations 
sections. For instance, under the rules in Secs. 404.1519, 404.1519g, 
416.919, and 416.919g, we may select a qualified medical source who is 
not an ``acceptable medical source'' to perform a consultative 
examination; e.g., an audiologist or speech and language pathologist.
    We also propose to add definitions for the terms ``nonexamining 
source'' and ``nontreating source,'' now used in Secs. 404.1527 and 
416.927, which are not currently defined in regulations. We propose to 
clarify the definition of ``treating source'' to include the other 
acceptable medical sources identified in Secs. 404.1513(a) and 
416.913(a) in addition to licensed physicians or licensed or certified 
psychologists, and, consistent with use of the word ``evaluation'' in 
the first sentence of the current definition in Secs. 404.1502 and 
416.902, to clarify that a source who only examines and evaluates an 
individual on an ongoing basis, but who does not provide any treatment, 
may also be a ``treating source.''
    We propose to delete the term ``source of record'' because sources 
previously included in the definition of that term are included in the 
definition of the terms ``acceptable medical source'' or ``medical 
source'' and the term ``source of record'' is not needed.

Clarification of Secs. 404.1527 and 416.927

    We propose to clarify, consistent with our original intent, 
paragraph (f) of Secs. 404.1527 and 416.927. As we explained in the 
preamble to the current rules published in the Federal Register on 
August 1, 1991 (56 FR 36932, 36937), the purpose of paragraph (f) is 
to: (1) Explain how we consider evidence from various kinds of 
nonexamining sources (e.g., State agency medical and psychological 
consultants, other program physicians and psychologists, and medical 
advisors--now called ``medical experts''--at the administrative law 
judge hearings and Appeals Council levels of administrative review), 
(2) clarify the role of the State agency medical and psychological 
consultant at the various levels of the administrative review process, 
and (3) codify in regulations our longstanding policy that, because 
State agency medical and psychological consultants are highly qualified 
physicians and psychologists who are also experts in Social Security 
disability evaluation, administrative law judges will consider their 
findings with regard to the nature and severity of an individual's 
impairment as opinions of nonexamining physicians and psychologists.
    Sections 404.1527(f) and 416.927(f) of the current regulations 
state that administrative law judges and the Appeals Council are 
required to consider State agency medical and psychological consultant 
findings about the existence and severity of an individual's 
impairment(s), the existence and severity of an individual's symptoms, 
whether an individual's impairment(s) meets or equals the requirements 
for any impairment listed in appendix 1 to subpart P of part 404, and 
an individual's residual functional capacity. We recently restated and 
clarified these provisions of the regulations in Social Security Ruling 
(SSR) 96-6p, ``Titles II and XVI: Consideration of Administrative 
Findings of Fact by State Agency Medical and Psychological Consultants 
and Other Program Physicians and Psychologists at the Administrative 
Law Judge and Appeals Council Levels of Administrative Review; Medical 
Equivalence.'' (61 FR 34466, July 2, 1996.)
    Consistent with our statements in the 1991 preamble to the current 
regulations and the clarifications in SSR 96-6p, we propose the 
following revisions to paragraph (f) of Secs. 404.1527 and 416.927. We 
also propose conforming revisions to paragraphs (d)(6) and (e). None of 
these proposed revisions is intended to change our current policies.
    Because paragraph (f) refers to the rules in paragraphs (a) through 
(e) of Secs. 404.1527 and 416.927, which collectively address both 
medical opinions (as described in paragraph (a)(2) of Secs. 404.1527 
and 416.927) and opinions on issues reserved to the Commissioner of 
Social Security (the Commissioner), it is inaccurate to refer

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in paragraph (f) solely to opinions on the ``nature and severity of a 
person's impairment(s).'' Therefore, we propose to delete the phrase 
``on the nature and severity of your impairments'' from the 
introductory text of paragraph (f). We also propose to revise paragraph 
(f)(2) to provide more detail on how administrative law judges are to 
consider the opinions of State agency medical and psychological 
consultants, other program physicians and psychologists, and medical 
experts we consult. The proposal would divide paragraph (f)(2) into an 
introductory paragraph and new paragraphs (f)(2)(i) through 
(f)(2)(iii), which would provide a more detailed explanation of how 
opinions from these sources are to be evaluated. The introductory text 
of paragraph (f)(2) and, when appropriate, paragraphs (f)(2)(i) through 
(f)(2)(iii), include reference to ``other program physicians and 
psychologists'' and the term ``medical expert'' for consistency with 
the current or proposed language in paragraph (b)(6) of Secs. 404.1512 
and 416.912.
    We propose to clarify in new paragraph (f)(2)(i) that, because 
State agency medical and psychological consultants and other program 
physicians and psychologists are highly qualified physicians and 
psychologists who are also experts in Social Security disability 
evaluation, administrative law judges must consider findings of these 
experts, except for the ultimate determination of disability, when they 
make their disability decisions. We propose to state in new paragraph 
(f)(2)(ii) that when administrative law judges evaluate the findings of 
these experts, they will use the relevant factors set forth in 
paragraphs (a) through (e) of Secs. 404.1527 and 416.927.
    In paragraph (f)(2)(ii) we also propose to provide examples of the 
kinds of factors that an administrative law judge must consider when 
evaluating the findings of State agency medical and psychological 
consultants or other program physicians and psychologists. We also 
propose to clarify that administrative law judges are required to 
explain in their decisions the weight given to any opinion of a State 
agency medical or psychological consultant or other program physician 
or psychologist, as they must do for any opinions from treating 
sources, nontreating sources, and nonexamining sources who do not work 
for us.
    In new paragraph (f)(2)(iii), we propose to substitute the term 
``medical expert'' for ``medical advisor'' for the reason explained 
below about paragraph (b)(6) of Secs. 404.1512 and 416.912. We also 
propose to make it clear in new paragraph (f)(2)(iii) that when 
administrative law judges consider opinions from medical experts they 
consult they will use the rules in paragraphs (a) through (e) of 
Secs. 404.1527 and 416.927.
    We also propose to amend paragraph (d)(6) of Secs. 404.1527 and 
416.927 by adding two examples of other factors that can affect the 
weight we give to a medical opinion. The amount of Social Security 
disability programs expertise an acceptable medical source has is a 
relevant factor that is consistent with the examples we propose to 
provide in paragraph (f)(2)(ii). This would include acceptable medical 
sources who are currently medical or psychological consultants and 
those who had been medical or psychological consultants, or other 
program physicians or psychologists, in the past. Another relevant 
factor is whether a source reviewed the individual's entire case record 
before providing a medical opinion. Both of these are relevant factors 
that we will consider in deciding the weight to give to a medical 
opinion from any acceptable medical source.
    We also propose to amend paragraph (e) of Secs. 404.1527 and 
416.927 by adding an introductory paragraph to distinguish opinions on 
issues reserved to the Commissioner from medical opinions, and by 
designating the last sentence of paragraph (e)(2) as new paragraph 
(e)(3) to make it clear that the rule in new paragraph (e)(3) applies 
to an opinion about disability described in paragraph (e)(1) as well as 
to an opinion on any issue reserved to the Commissioner described in 
paragraph (e)(2).

Other Changes

Sections 404.1502 and 416.902  General Definitions and Terms for This 
Subpart

    In Secs. 404.1502 and 416.902, we propose to clarify, consistent 
with current Secs. 404.602 and 416.302, the definition of the term 
``you'' to more accurately indicate that the definition includes the 
person for whom an application is filed because the person who files an 
application may be filing it on behalf of another person.
    Also, in keeping with the President's goal of streamlining and 
simplifying regulations, we propose to delete the term ``Secretary'' 
and its definition from Sec. 404.1502 and to delete the terms 
``Commissioner'' (see 62 FR 6408, February 11, 1997) and ``Secretary'' 
from Sec. 416.902 because we define these terms for the entire parts 
404 and 416 in Secs. 404.2(b) and 416.120(b).

Sections 404.1512 and 416.912  Evidence of Your Impairment

    We propose to amend Secs. 404.1512 and 416.912 by revising 
paragraph (b)(6) to delete the word ``certain'' to clarify that every 
finding made by State agency medical or psychological consultants and 
other program physicians or psychologists and the opinions of medical 
experts, other than the ultimate determination about whether an 
individual is disabled, is evidence that an administrative law judge 
and the Appeals Council must consider at the administrative law judge 
and Appeals Council levels of review. We also propose to change the 
term ``medical advisor'' to ``medical expert'' because the latter is 
the term we currently use to describe these nonexamining sources we 
consult at the administrative law judge and Appeals Council levels.

Sections 404.1513 and 416.913  Medical Evidence of Your Impairment

    We propose to revise paragraph (c) of Secs. 404.1513 and 416.913 to 
codify our policy interpretation that, at the administrative law judge 
and Appeals Council levels of review, ``statements about what you can 
still do,'' which we also call ``medical source statements,'' include 
residual functional capacity assessments made by State agency medical 
and psychological consultants and other program physicians and 
psychologists. This is because they become opinion evidence of 
nonexamining physicians and psychologists at the hearings and appeals 
levels. (See SSR 96-6p, 61 FR 34466, 34468.)
    Because paragraphs (b) and (c) relate to the reports about an 
individual's impairment(s) needed from acceptable medical sources 
described in paragraph (a), we propose to clarify paragraphs (b)(6), 
(c)(1) and (c)(2) of Sec. 404.1513 and paragraphs (b)(6), (c)(1), 
(c)(2), and (c)(3) of Sec. 416.913 to refer to findings and opinions of 
the ``acceptable medical source,'' rather than findings and opinions of 
the ``medical source.'' We also propose to clarify paragraphs (c)(1) 
and (c)(2) of Sec. 416.913 by indicating that they pertain only to 
adults, to make the construction of these paragraphs parallel to that 
of paragraph (c)(3), which pertains only to children.

Sections 404.1519 and 416.919  The Consultative Examination

    We propose to revise Secs. 404.1519 and 416.919 to substitute the 
terms ``treating source'' and ``medical source'' for the terms 
``treating physician or psychologist,'' ``source of record'' and

[[Page 50273]]

``independent source'' in the first sentence.

Sections 404.1519g and 416.919g  Who We Will Select To Perform a 
Consultative Examination

    We propose to revise paragraph (a) to refer in the last sentence to 
Secs. 404.1513 and 416.913, rather than Secs. 404.1513(a) and 
416.913(a), for the reasons explained above about the proposed revised 
definition of ``medical source'' in Secs. 404.1502 and 416.902. For the 
same reason, we would also change the phrase ``physician or 
psychologist'' in the first sentence of paragraph (c) to ``medical 
source.''

Sections 404.1519h and 416.919h  Your Treating Physician or 
Psychologist

    We propose to revise the heading and text of these sections to 
substitute the term ``treating source'' for the term ``treating 
physician or psychologist.''

Sections 404.1519i and 416.919i  Other Sources for Consultative 
Examinations

    We propose to revise the text of these sections to substitute the 
term ``treating source'' for the term ``treating physician or 
psychologist.''

Sections 404.1519j and 416.919j  Objections to the Designated Physician 
or Psychologist

    We propose to revise the heading and text of these sections to use 
the term ``medical source,'' rather than the phrase ``physician or 
psychologist,'' for the reasons explained above.

Sections 404.1519k and 416.919k  Purchase of Medical Examinations, 
Laboratory Tests, and Other Services

    We propose to revise the introductory paragraph of these sections 
to use the term ``medical source,'' rather than the phrase ``licensed 
physician or psychologist, hospital or clinic'' for the reasons 
explained above.

Sections 404.1519m and 416.919m Diagnostic Tests or Procedures

    We propose to revise the first sentence of these sections to 
substitute the term ``treating source'' for the term ``treating 
physician or psychologist.'' We also propose to revise the last 
sentence to use the term ``medical source,'' rather than the phrase 
``physician or psychologist,'' for the reasons explained above.

Sections 404.1519n and 416.919n Informing the Examining Physician or 
Psychologist of Examination Scheduling, Report Content, and Signature 
Requirements

    We propose to revise the heading, introductory paragraph, and 
paragraphs (a), (b), (c), and (e) to use the term ``medical source,'' 
rather than the phrase ``physician or psychologist,'' for the reasons 
explained above. We would also add a heading to paragraph (a) for 
consistency with the other paragraphs in this section. In addition, we 
would revise paragraph (c)(6) to insert language that we intended to 
include, as explained in our statements in the 1991 preamble (56 FR 
36932, 36934, August 1, 1991) to the current regulations, but 
inadvertently omitted, to ensure that although medical source 
statements about what an individual can still do despite his or her 
impairment(s) should ordinarily be requested as part of the 
consultative examination process, the absence of such a statement in a 
consultative examination report does not make the report incomplete.

Sections 404.1519o and 416.919o  When a Properly Signed Consultative 
Examination Report Has Not Been Received

    We propose to revise paragraphs (a) and (b) to use the term 
``medical source,'' rather than the phrase ``physician or 
psychologist,'' for the reasons explained above.

Sections 404.1519p and 416.919p Reviewing Reports of Consultative 
Examinations

    We propose to revise paragraph (b) to use the term ``medical 
source,'' rather than the phrase ``physician or psychologist,'' for the 
reasons explained above. We would revise paragraph (c) to correct the 
grammar in the first sentence by substituting the word ``when'' for the 
word ``where.'' We also propose to substitute the term ``treating 
source'' for the term ``treating physician or psychologist.''

Sections 404.1519s and 416.919s  Authorizing and Monitoring the 
Consultative Examination

    We propose to revise paragraph (e)(2) to refer to a consultative 
examination provider's ``practice,'' rather than to a ``practice of 
medicine, osteopathy, or psychology,'' for the reasons explained above 
about the definition of ``medical source.'' For the same reasons, we 
would also use the term ``medical sources'' in paragraph (f)(6), rather 
than the phrase ``physicians and psychologists.''

Sections 404.1527 and 416.927  Evaluating Medical Opinions About Your 
Impairment(s) or Disability

    We propose to change the heading of Secs. 404.1527 and 416.927 from 
``Evaluating medical opinions about your impairment(s) or disability'' 
to ``Evaluating opinion evidence'' to more accurately identify the 
content of these sections. Under current Secs. 404.1527(a)(2) and 
416.927(a)(2), the term ``medical opinion'' means statements from 
acceptable medical sources that reflect judgments about the nature and 
severity of an individual's impairments, but Secs. 404.1527 and 416.927 
address other types of opinions, too.
    We propose to revise the third sentence of paragraph (d)(2) of 
Secs. 404.1527 and 416.927 to clarify that the ``other factors'' 
referenced in paragraph (d)(6) will be considered along with the 
factors in paragraphs (d)(2) (i) and (ii) and paragraphs (d)(3) through 
(d)(5) of this section when we do not give a treating source's medical 
opinion controlling weight. As indicated by the current introductory 
text to Secs. 404.1527(d) and 416.927(d), exclusion of reference to 
paragraph (d)(6) was an inadvertent omission when the current rule was 
published. (56 FR 36932, August 1, 1991.)
    We propose to change the heading of paragraph (e) in Secs. 404.1527 
and 416.927 to reflect that the Commissioner, not the Secretary of 
Health and Human Services, has the authority on these issues pursuant 
to section 702(a)(5) of the Act as amended by section 102 of the Social 
Security Independence and Program Improvements Act of 1994, Public Law 
103-296, enacted on August 15, 1994. We also propose to change the 
second sentence of paragraph (e)(2) to substitute the term ``medical 
sources'' for the phrase ``treating and examining sources'' to be 
consistent with the use of the term ``medical sources'' in the first 
sentence of paragraph (e)(2) and to clarify that we consider opinions 
from all medical sources on the issues described in the second 
sentence.
    We also propose to shorten the heading of paragraph (f) of 
Secs. 404.1527 and 416.927 to ``Opinions of nonexamining sources,'' 
consistent with the proposed definitions in Secs. 404.1502 and 416.902. 
For the same reason, we propose to substitute the term ``nonexamining 
sources'' for ``nonexamining physicians and psychologists'' in the 
first sentence of paragraph (f).

Electronic Versions

    The electronic file of this document is available on the Federal 
Bulletin Board (FBB) at 9:00 a.m. on the date of publication in the 
Federal Register. To download the file, modem dial (202) 512-1387. The 
FBB instructions will explain how to download the file and the fee. 
This file is in WordPerfect and

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will remain on the FBB during the comment period.

Regulatory Procedures

Executive Order 12866

    We have consulted with the Office of Management and Budget (OMB) 
and determined that these proposed rules do not meet the criteria for a 
significant regulatory action under Executive Order 12866. Therefore, 
they are not subject to OMB review.

Regulatory Flexibility Act

    We certify that these proposed regulations will not have a 
significant economic impact on a substantial number of small entities 
because they affect only individuals. Therefore, a regulatory 
flexibility analysis as provided in the Regulatory Flexibility Act, as 
amended, is not required.

Paperwork Reduction Act

    These proposed regulations impose no additional reporting or 
recordkeeping requirements subject to OMB clearance.

(Catalog of Federal Domestic Assistance Program Nos. 96.001, Social 
Security-Disability Insurance; 96.002, Social Security-Retirement 
Insurance; 96.004, Social Security-Survivors Insurance; 96.006, 
Supplemental Security Income)

List of Subjects

20 CFR Part 404

    Administrative practice and procedure, Blind, Disability benefits, 
Old-Age, Survivors, and Disability Insurance, Reporting and 
recordkeeping requirements, Social Security.

20 CFR Part 416

    Administrative practice and procedure, Aged, Blind, Disability 
benefits, Public assistance programs, Supplemental Security Income 
(SSI), Reporting and recordkeeping requirements.

    Dated: September 12, 1997.
John J. Callahan,
Acting Commissioner of Social Security.

    For the reasons set out in the preamble, we propose to amend 
subpart P of part 404 and subpart I of part 416 of 20 CFR chapter III 
as set forth below:

PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE 
(1950-    )

Subpart P--[Amended]

    1. The authority citation for subpart P of part 404 continues to 
read as follows:

    Authority: Secs. 202, 205(a), (b), and (d)-(h), 216(i), 221(a) 
and (i), 222(c), 223, 225, and 702(a)(5) of the Social Security Act 
(42 U.S.C. 402, 405(a), (b), and (d)-(h), 416(i), 421(a) and (i), 
422(c), 423, 425, and 902(a)(5)); sec. 211(b), Pub. L. 104-193, 110 
Stat. 2105, 2189.

    2. Section 404.1502 is amended by removing the term ``Source of 
record'' and its definition, revising the definitions of ``Medical 
sources'' and ``Treating source,'' changing the term ``You'' to ``You 
or your'' and revising its definition, and adding definitions in the 
appropriate alphabetical order for the terms ``Acceptable medical 
source,'' ``Nonexamining source,'' and ``Nontreating source'' to read 
as follows:


Sec. 404.1502  General definitions and terms for this subpart.

    As used in the subpart--
    Acceptable medical source refers to one of the sources described in 
Sec. 404.1513(a) who provides evidence about your impairments. It 
includes treating sources, nontreating sources, and nonexamining 
sources.
    Medical sources refers to acceptable medical sources, or other 
health care providers who are not acceptable medical sources.
    Nonexamining source means a physician, psychologist, or other 
acceptable medical source who has not examined you but provides a 
medical or other opinion in your case. At the administrative law judge 
hearing and Appeals Council levels of the administrative review 
process, it includes State agency medical and psychological 
consultants, other program physicians and psychologists, and medical 
experts we consult. See Sec. 404.1527.
    Nontreating source means a physician, psychologist, or other 
acceptable medical source who has examined you but does not have, or 
did not have, an ongoing treatment relationship with you. The term 
includes an acceptable medical source who is a consultative examiner 
for us, when the consultative examiner is not your treating source. See 
Sec. 404.1527.
* * * * *
    Treating source means your own physician, psychologist, or other 
acceptable medical source who provides you, or has provided you, with 
medical treatment or evaluation and who has, or has had, an ongoing 
treatment relationship with you. Generally, we will consider that you 
have an ongoing treatment relationship with an acceptable medical 
source when the medical evidence establishes that you see, or have 
seen, the source with a frequency consistent with accepted medical 
practice for the type of treatment and/or evaluation required for your 
medical condition(s). We may consider an acceptable medical source who 
has treated or evaluated you only a few times or only after long 
intervals (e.g., twice a year) to be your treating source if the nature 
and frequency of the treatment or evaluation is typical for your 
condition(s). We will not consider an acceptable medical source to be 
your treating source if your relationship with the source is not based 
on your medical need for treatment or evaluation, but solely on your 
need to obtain a report in support of your claim for disability. In 
such a case, we will consider the acceptable medical source to be a 
nontreating source.
* * * * *
    You or your means, as appropriate, the person who applies for 
benefits or for a period of disability, the person for whom an 
application is filed, or the person who is receiving benefits based on 
disability or blindness.
    3. Section 404.1512 is amended by revising paragraph (b)(6) to read 
as follows:


Sec. 404.1512  Evidence of your impairment.

* * * * *
    (b) * * *
    (6) At the administrative law judge and Appeals Council levels, 
findings, other than the ultimate determination about whether you are 
disabled, made by State agency medical or psychological consultants and 
other program physicians or psychologists, and opinions expressed by 
medical experts we consult based on their review of the evidence in 
your case record. See Secs. 404.1527(f)(2) and (f)(3).
* * * * *
    4. Section 404.1513 is amended by revising the first sentence of 
paragraph (b)(6) and paragraph (c) to read as follows:


Sec. 404.1513  Medical evidence of your impairment.

* * * * *
    (b) * * *
    (6) A statement about what you can still do despite your 
impairment(s) based on the acceptable medical source's findings on the 
factors under paragraphs (b)(1) through (b)(5) of this section (except 
in statutory blindness claims). * * *
    (c) Statements about what you can still do. At the administrative 
law judge and Appeals Council levels, we will consider residual 
functional capacity assessments made by State agency medical and 
psychological consultants and other program physicians and 
psychologists to be ``statements about what you can still do'' made by 
nonexamining physicians and

[[Page 50275]]

psychologists based on their review of the evidence in the case record. 
Statements about what you can still do (based on the acceptable medical 
source's findings on the factors under paragraphs (b)(1) through (b)(5) 
of this section) should describe, but are not limited to, the kinds of 
physical and mental capabilities listed below. See Secs. 404.1527 and 
404.1545(c).
    (1) The acceptable medical source's opinion about your ability, 
despite your impairment(s), to do work-related activities such as 
sitting, standing, walking, lifting, carrying, handling objects, 
hearing, speaking, and traveling; and
    (2) In cases of mental impairment(s), the acceptable medical 
source's opinion about your ability to understand, to carry out and 
remember instructions, and to respond appropriately to supervision, 
coworkers, and work pressures in a work setting.
* * * * *
    5. Section 404.1519 is amended by revising the first sentence to 
read as follows:


Sec. 404.1519  The consultative examination.

    A consultative examination is a physical or mental examination or 
test purchased for you at our request and expense from a treating 
source or another medical source, including a pediatrician when 
appropriate. * * *
    6. Section 404.1519g is amended by revising the last sentence of 
paragraph (a) and the first sentence of paragraph (c) to read as 
follows:


Sec. 404.1519g  Who we will select to perform a consultative 
examination.

    (a) * * * For a more complete list of medical sources, see 
Sec. 404.1513.
* * * * *
    (c) The medical source we choose may use support staff to help 
perform the consultative examination. * * *
    7. Section 404.1519h is revised to read as follows:


Sec. 404.1519h  Your treating source.

    When in our judgment your treating source is qualified, equipped, 
and willing to perform the additional examination or tests for the fee 
schedule payment, and generally furnishes complete and timely reports, 
your treating source will be the preferred source to do the purchased 
examination. Even if only a supplemental test is required, your 
treating source is ordinarily the preferred source.
    8. Section 404.1519i is revised to read as follows:


Sec. 404.1519i  Other sources for consultative examinations.

    We will use a source other than your treating source for a 
purchased examination or test in situations including, but not limited 
to, the following situations:
    (a) Your treating source prefers not to perform such an examination 
or does not have the equipment to provide the specific data needed;
    (b) There are conflicts or inconsistencies in your file that cannot 
be resolved by going back to your treating source;
    (c) You prefer a source other than your treating source and have a 
good reason for your preference;
    (d) We know from prior experience that your treating source may not 
be a productive source, e.g., he or she has consistently failed to 
provide complete or timely reports.
    9. Section 404.1519j is revised to read as follows:


Sec. 404.1519j  Objections to the medical source designated to perform 
the consultative examination.

    You or your representative may object to your being examined by a 
medical source we have designated to perform a consultative 
examination. If there is a good reason for the objection, we will 
schedule the examination with another medical source. A good reason may 
be that the medical source we designated had previously represented an 
interest adverse to you. For example, the medical source may have 
represented your employer in a workers' compensation case or may have 
been involved in an insurance claim or legal action adverse to you. 
Other things we will consider include: The presence of a language 
barrier, the medical source's office location (e.g., 2nd floor, no 
elevator), travel restrictions, and whether the medical source had 
examined you in connection with a previous disability determination or 
decision that was unfavorable to you. If your objection is that a 
medical source allegedly ``lacks objectivity'' in general, but not in 
relation to you personally, we will review the allegations. See 
Sec. 404.1519s. To avoid a delay in processing your claim, the 
consultative examination in your case will be changed to another 
medical source while a review is being conducted. We will handle any 
objection to use of the substitute medical source in the same manner. 
However, if we had previously conducted such a review and found that 
the reports of the medical source in question conformed to our 
guidelines, we will not change your examination.
    10. Section 404.1519k is amended by revising the introductory 
paragraph to read as follows:


Sec. 404.1519k  Purchase of medical examinations, laboratory tests, and 
other services.

    We may purchase medical examinations, including psychiatric and 
psychological examinations, X-rays and laboratory tests (including 
specialized tests, such as pulmonary function studies, 
electrocardiograms, and stress tests) from a medical source.
* * * * *
    11. Section 404.1519m is amended by revising the first and last 
sentences to read as follows:


Sec. 404.1519m  Diagnostic tests or procedures.

    We will request the results of any diagnostic tests or procedures 
that have been performed as part of a workup by your treating source or 
other medical source and will use the results to help us evaluate 
impairment severity or prognosis. * * * The responsibility for deciding 
whether to perform the examination rests with the consultative 
examining medical source.
    12. Section 404.1519n is amended by revising the heading and the 
first and last sentences of the introductory paragraph, adding a 
heading to and revising the first sentence of paragraph (a), revising 
the last two sentences of paragraph (b), revising the second sentence 
of and adding third and fourth sentences to paragraph (c)(6), and 
revising paragraphs (c)(7) and (e) to read as follows:


Sec. 404.1519n  Informing the medical source of examination scheduling, 
report content, and signature requirements.

    The medical sources who perform consultative examinations will have 
a good understanding of our disability programs and their evidentiary 
requirements. * * * We will fully inform medical sources who perform 
consultative examinations at the time we first contact them, and at 
subsequent appropriate intervals, of the following obligations:
    (a) Scheduling. In scheduling full consultative examinations, 
sufficient time should be allowed to permit the medical source to take 
a case history and perform the examination, including any needed tests. 
* * *
    (b) Report content. * * * The report should reflect your statement 
of your symptoms, not simply the medical source's statements or 
conclusions. The examining medical source's report of the consultative 
examination should include the objective medical facts as well as 
observations and opinions.

[[Page 50276]]

    (c) *  * *
    (6) * * * This statement should describe the opinion of the medical 
source about your ability, despite your impairment(s), to do work-
related activities, such as sitting, standing, walking, lifting, 
carrying, handling objects, hearing, speaking, and traveling; and, in 
cases of mental impairment(s), the opinion of the medical source about 
your ability to understand, to carry out and remember instructions, and 
to respond appropriately to supervision, coworkers and work pressures 
in a work setting. Although we will ordinarily request, as part of the 
consultative examination process, a medical source statement about what 
you can still do despite your impairment(s), the absence of such a 
statement in a consultative examination report will not make the report 
incomplete. See Sec. 404.1527; and
    (7) In addition, the medical source will consider, and provide some 
explanation or comment on, your major complaint(s) and any other 
abnormalities found during the history and examination or reported from 
the laboratory tests. The history, examination, evaluation of 
laboratory test results, and the conclusions will represent the 
information provided by the medical source who signs the report.
* * * * *
    (e) Signature requirements. All consultative examination reports 
will be personally reviewed and signed by the medical source who 
actually performed the examination. This attests to the fact that the 
medical source doing the examination or testing is solely responsible 
for the report contents and for the conclusions, explanations or 
comments provided with respect to the history, examination and 
evaluation of laboratory test results. The signature of the medical 
source on a report annotated ``not proofed'' or ``dictated but not 
read'' is not acceptable. A rubber stamp signature of a medical source 
or the medical source's signature entered by any other person is not 
acceptable.
    13. Section 404.1519o is amended by revising the second sentence of 
paragraph (a) and the third sentence of paragraph (b) to read as 
follows:


Sec. 404.1519o  When a properly signed consultative examination report 
has not been received.

* * * * *
    (a) When we will make determinations and decisions without a 
properly signed report. * * * After we have made the determination or 
decision, we will obtain a properly signed report and include it in the 
file unless the medical source who performed the original consultative 
examination has died.
* * * * *
    (b) When we will not make determinations and decisions without a 
properly signed report. * * * If the signature of the medical source 
who performed the original examination cannot be obtained because the 
medical source is out of the country for an extended period of time, or 
on an extended vacation, seriously ill, deceased, or for any other 
reason, the consultative examination will be rescheduled with another 
medical source.
* * * * *
    14. Section 404.1519p is amended by revising paragraphs (b) and (c) 
to read as follows:


Sec. 404.1519p  Reviewing reports of consultative examinations.

* * * * *
    (b) If the report is inadequate or incomplete, we will contact the 
medical source who performed the consultative examination, give an 
explanation of our evidentiary needs, and ask that the medical source 
furnish the missing information or prepare a revised report.
    (c) With your permission, or when the examination discloses new 
diagnostic information or test results that reveal potentially life-
threatening situations, we will refer the consultative examination 
report to your treating source. When we refer the consultative 
examination report to your treating source without your permission, we 
will notify you that we have done so.
* * * * *
    15. Section 404.1519s is amended by revising paragraph (e)(2) and 
the first sentence of paragraph (f)(6) to read as follows:


Sec. 404.1519s  Authorizing and monitoring the consultative 
examination.

* * * * *
    (e) * * *
    (2) Any consultative examination provider with a practice directed 
primarily towards evaluation examinations rather than the treatment of 
patients; or
* * * * *
    (f) * * *
    (6) Procedures for providing medical or supervisory approval for 
the authorization or purchase of consultative examinations and for 
additional tests or studies requested by consulting medical sources. * 
* *
* * * * *
    16. Section 404.1527 is amended by revising the section heading, 
the third sentence of paragraph (d)(2), the heading of paragraph (e), 
paragraph (e)(2), the heading and introductory text of paragraph (f), 
and paragraph (f)(2), by adding a sentence to paragraph (d)(6), by 
adding introductory text to paragraph (e), and by adding paragraph 
(e)(3) to read as follows:


Sec. 404.1527  Evaluating opinion evidence.

* * * * *
    (d) * * *
    (2) Treatment relationship. * * * When we do not give the treating 
source's opinion controlling weight, we apply the factors listed below, 
as well as the factors in paragraphs (d)(3) through (d)(6) of this 
section in determining the weight to give the opinion. * * *
* * * * *
    (6) Other factors. * * * For example, the amount of Social Security 
disability programs expertise an acceptable medical source has and 
whether an acceptable medical source reviewed the individual's entire 
case record before providing a medical opinion are relevant factors 
that we will consider in deciding the weight to give to a medical 
opinion.
    (e) Medical source opinions on issues reserved to the Commissioner. 
Opinions on some issues, such as the examples that follow, are not 
medical opinions, as described in paragraph (a)(2) of this section, but 
are, instead, opinions on issues reserved to the Commissioner because 
they are administrative findings that are dispositive of a case; i.e., 
that would direct the determination or decision of disability.
* * * * *
    (2) Other opinions on issues reserved to the Commissioner. We use 
medical sources, including your treating source, to provide evidence, 
including opinions, on the nature and severity of your impairment(s). 
Although we consider opinions from medical sources on issues such as 
whether your impairment(s) meets or equals the requirements of any 
impairment(s) in the Listing of Impairments in appendix 1 to this 
subpart, your residual functional capacity (see Secs. 404.1545 and 
404.1546), or the application of vocational factors, the final 
responsibility for deciding these issues is reserved to the 
Commissioner.
    (3) We will not give any special significance to the source of an 
opinion on issues reserved to the Commissioner described in paragraphs 
(e)(1) and (e)(2) of this section.
    (f) Opinions of nonexamining sources. We consider all evidence from 
nonexamining sources to be opinion evidence. When we consider the 
opinions of nonexamining sources, we

[[Page 50277]]

apply the rules in paragraphs (a) through (e) of this section. In 
addition, the following rules apply to State agency medical and 
psychological consultants, other program physicians and psychologists, 
and medical experts we consult in connection with administrative law 
judge hearings and Appeals Council review.
* * * * *
    (2) Administrative law judges are responsible for reviewing the 
evidence and making findings of fact and conclusions of law. They will 
consider opinions of State agency medical or psychological consultants, 
other program physicians and psychologists, and medical experts as 
follows:
    (i) Administrative law judges are not bound by any findings made by 
State agency medical or psychological consultants, or other program 
physicians or psychologists. However, State agency medical and 
psychological consultants and other program physicians and 
psychologists are highly qualified physicians and psychologists who are 
also experts in Social Security disability evaluation. Therefore, 
administrative law judges must consider findings of State agency 
medical and psychological consultants or other program physicians or 
psychologists, except for the ultimate determination about whether you 
are disabled. See Sec. 404.1512(b)(6).
    (ii) When administrative law judges consider findings of State 
agency medical or psychological consultants or other program physicians 
or psychologists, they will evaluate the findings using relevant 
factors in paragraphs (a) through (e) of this section, such as the 
medical or psychological consultants', or other program physicians' or 
psychologists', medical specialty and expertise in our rules, the 
evidence reviewed by the consultants or other program physicians or 
psychologists, supporting explanations provided by the consultants or 
other program physicians or psychologists, and any other factors 
relevant to the weighing of the opinions. he administrative law judge 
must explain in the decision the weight given to the opinions of a 
State agency medical or psychological consultant or other program 
physician or psychologist, as the administrative law judge must do for 
any opinions from treating sources, nontreating sources, and 
nonexamining sources who do not work for us.
    (iii) Administrative law judges may also ask for and consider 
opinions from medical experts on the nature and severity of your 
impairment(s) and on whether your impairment(s) equals the requirements 
of any impairment listed in appendix 1 to this subpart. When 
administrative law judges consider these opinions, they will evaluate 
them using the rules in paragraphs (a) through (e) of this section.
* * * * *

PART 416--SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND 
DISABLED

Subpart I--[Amended]

    17. The authority citation for subpart I of part 416 continues to 
read as follows:

    Authority: Secs. 702(a)(5), 1611, 1614, 1619, 1631(a), (c), and 
(d)(1), and 1633 of the Social Security Act (42 U.S.C. 902(a)(5), 
1382, 1382c, 1382h, 1383(a), (c), and (d)(1), and 1383b); secs. 4(c) 
and 5, 6(c)-(e), 14(a) and 15, Pub. L. 98-460, 98 Stat. 1794, 1801, 
1802, and 1808 (42 U.S.C. 421 note, 423 note, 1382h note).

    18. Section 416.902 is amended by removing the terms 
``Commissioner,'' ``Secretary,'' and ``Source of record'' and their 
definitions, revising the definitions of ``Medical sources'' and 
``Treating source,'' changing the term ``You'' to ``You or your'' and 
revising its definition, and adding definitions in the appropriate 
alphabetical order for the terms ``Acceptable medical source,'' 
``Nonexamining source,'' and ``Nontreating source'' to read as follows:


Sec. 416.902  General definitions and terms for this subpart.

    As used in the subpart--
    Acceptable medical source refers to one of the sources described in 
Sec. 416.913(a) who provides evidence about your impairments. It 
includes treating sources, nontreating sources, and nonexamining 
sources.
* * * * *
    Medical sources refers to acceptable medical sources, or other 
health care providers who are not acceptable medical sources.
    Nonexamining source means a physician, psychologist, or other 
acceptable medical source who has not examined you but provides a 
medical or other opinion in your case. At the administrative law judge 
hearing and Appeals Council levels of the administrative review 
process, it includes State agency medical and psychological 
consultants, other program physicians and psychologists, and medical 
experts we consult. See Sec. 416.927.
    Nontreating source means a physician, psychologist, or other 
acceptable medical source who has examined you but does not have, or 
did not have, an ongoing treatment relationship with you. The term 
includes an acceptable medical source who is a consultative examiner 
for us, when the consultative examiner is not your treating source. See 
Sec. 416.927.
* * * * *
    Treating source means your own physician, psychologist, or other 
acceptable medical source who provides you, or has provided you, with 
medical treatment or evaluation and who has, or has had, an ongoing 
treatment relationship with you. Generally, we will consider that you 
have an ongoing treatment relationship with an acceptable medical 
source when the medical evidence establishes that you see, or have 
seen, the source with a frequency consistent with accepted medical 
practice for the type of treatment and/or evaluation required for your 
medical condition(s). We may consider an acceptable medical source who 
has treated or evaluated you only a few times or only after long 
intervals (e.g., twice a year) to be your treating source if the nature 
and frequency of the treatment or evaluation is typical for your 
condition(s). We will not consider an acceptable medical source to be 
your treating source if your relationship with the source is not based 
on your medical need for treatment or evaluation, but solely on your 
need to obtain a report in support of your claim for disability. In 
such a case, we will consider the acceptable medical source to be a 
nontreating source.
* * * * *
    You or your means, as appropriate, the person who applies for 
benefits, the person for whom an application is filed, or the person 
who is receiving benefits based on disability or blindness.
    19. Section 416.912 is amended by revising paragraph (b)(6) to read 
as follows:


Sec. 416.912  Evidence of your impairment.

* * * * *
    (b) * * *
    (6) At the administrative law judge and Appeals Council levels, 
findings, other than the ultimate determination about whether you are 
disabled, made by State agency medical or psychological consultants and 
other program physicians or psychologists, and opinions expressed by 
medical experts we consult based on their review of the evidence in 
your case record. See Secs. 416.927(f)(2) and (f)(3).
* * * * *
    20. Section 416.913 is amended by revising the first sentence of 
paragraph

[[Page 50278]]

(b)(6) and paragraph (c) to read as follows:


Sec. 416.913  Medical evidence of your impairment.

* * * * *
    (b) * * *
    (6) A statement about what you can still do despite your 
impairment(s) based on the acceptable medical source's findings on the 
factors under paragraphs (b)(1) through (b)(5) of this section (except 
in statutory blindness claims). * * *
    (c) Statements about what you can still do. At the administrative 
law judge and Appeals Council levels, we will consider residual 
functional capacity assessments made by State agency medical and 
psychological consultants and other program physicians and 
psychologists to be ``statements about what you can still do'' made by 
nonexamining physicians and psychologists based on their review of the 
evidence in the case record. Statements about what you can still do 
(based on the acceptable medical source's findings on the factors under 
paragraphs (b)(1) through (b)(5) of this section) should describe, but 
are not limited to, the kinds of physical and mental capabilities 
listed below. See Secs. 416.927 and 416.945(c).
    (1) If you are an adult, the acceptable medical source's opinion 
about your ability, despite your impairment(s), to do work-related 
activities such as sitting, standing, walking, lifting, carrying, 
handling objects, hearing, speaking, and traveling; and
    (2) If you are an adult, in cases of mental impairment(s), the 
acceptable medical source's opinion about your ability to understand, 
to carry out and remember instructions, and to respond appropriately to 
supervision, coworkers, and work pressures in a work setting.
    (3) If you are a child, the acceptable medical source's opinion 
about your functional limitations in learning, motor functioning, 
performing self-care activities, communicating, socializing, and 
completing tasks (and, if you are a newborn or young infant from birth 
to age 1, responsiveness to stimuli).
* * * * *
    21. Section 416.919 is amended by revising the first sentence to 
read as follows:


Sec. 416.919  The consultative examination.

    A consultative examination is a physical or mental examination or 
test purchased for you at our request and expense from a treating 
source or another medical source, including a pediatrician when 
appropriate. * * *
    22. Section 416.919g is amended by revising the last sentence of 
paragraph (a) and the first sentence of paragraph (c) to read as 
follows:


Sec. 416.919g  Who we will select to perform a consultative 
examination.

    (a) * * * For a more complete list of medical sources, see 
Sec. 416.913.
* * * * *
    (c) The medical source we choose may use support staff to help 
perform the consultative examination. * * *
    23. Section 416.919h is revised to read as follows:


Sec. 416.919h  Your treating source.

    When in our judgment your treating source is qualified, equipped, 
and willing to perform the additional examination or tests for the fee 
schedule payment, and generally furnishes complete and timely reports, 
your treating source will be the preferred source to do the purchased 
examination. Even if only a supplemental test is required, your 
treating source is ordinarily the preferred source.
    24. Section 416.919i is revised to read as follows:


Sec. 416.919i  Other sources for consultative examinations.

    We will use a source other than your treating source for a 
purchased examination or test in situations including, but not limited 
to, the following situations:
    (a) Your treating source prefers not to perform such an examination 
or does not have the equipment to provide the specific data needed;
    (b) There are conflicts or inconsistencies in your file that cannot 
be resolved by going back to your treating source;
    (c) You prefer a source other than your treating source and have a 
good reason for your preference;
    (d) We know from prior experience that your treating source may not 
be a productive source, e.g., he or she has consistently failed to 
provide complete or timely reports.
    25. Section 416.919j is revised to read as follows:


Sec. 416.919j  Objections to the medical source designated to perform a 
consultative examination.

    You or your representative may object to your being examined by a 
medical source we have designated to perform a consultative 
examination. If there is a good reason for the objection, we will 
schedule the examination with another medical source. A good reason may 
be that the medical source we designated had previously represented an 
interest adverse to you. For example, the medical source may have 
represented your employer in a workers' compensation case or may have 
been involved in an insurance claim or legal action adverse to you. 
Other things we will consider include: The presence of a language 
barrier, the medical source's office location (e.g., 2nd floor, no 
elevator), travel restrictions, and whether the medical source had 
examined you in connection with a previous disability determination or 
decision that was unfavorable to you. If your objection is that a 
medical source allegedly ``lacks objectivity'' in general, but not in 
relation to you personally, we will review the allegations. See 
Sec. 416.919s. To avoid a delay in processing your claim, the 
consultative examination in your case will be changed to another 
medical source while a review is being conducted. We will handle any 
objection to use of the substitute medical source in the same manner. 
However, if we had previously conducted such a review and found that 
the reports of the medical source in question conformed to our 
guidelines, we will not change your examination.
    26. Section 416.919k is amended by revising the introductory 
paragraph to read as follows:


Sec. 416.919k  Purchase of medical examinations, laboratory tests, and 
other services.

    We may purchase medical examinations, including psychiatric and 
psychological examinations, X-rays and laboratory tests (including 
specialized tests, such as pulmonary function studies, 
electrocardiograms, and stress tests) from a medical source.
* * * * *
    27. Section 416.919m is amended by revising the first and last 
sentences to read as follows:


Sec. 416.919m  Diagnostic tests or procedures.

    We will request the results of any diagnostic tests or procedures 
that have been performed as part of a workup by your treating source or 
other medical source and will use the results to help us evaluate 
impairment severity or prognosis. * * * The responsibility for deciding 
whether to perform the examination rests with the consultative 
examining medical source.
    28. Section 416.919n is amended by revising the heading and the 
first and last sentences of the introductory paragraph, adding a 
heading to and revising the first sentence of paragraph (a), revising 
the last two sentences of paragraph (b), revising the second and third 
sentences of and adding fourth and fifth sentences to paragraph (c)(6),

[[Page 50279]]

and revising paragraphs (c)(7) and (e) to read as follows:


Sec. 416.919n  Informing the medical source of examination scheduling, 
report content, and signature requirements.

    The medical sources who perform consultative examinations will have 
a good understanding of our disability programs and their evidentiary 
requirements. * * * We will fully inform medical sources who perform 
consultative examinations at the time we first contact them, and at 
subsequent appropriate intervals, of the following obligations:
    (a) Scheduling. In scheduling full consultative examinations, 
sufficient time should be allowed to permit the medical source to take 
a case history and perform the examination, including any needed tests. 
* * *
* * * * *
    (b) Report content. * * * The report should reflect your statement 
of your symptoms, not simply the medical source's statements or 
conclusions. The examining medical source's report of the consultative 
examination should include the objective medical facts as well as 
observations and opinions.
    (c) * * *
* * * * *
    (6) * * * If you are an adult, this statement should describe the 
opinion of the medical source about your ability, despite your 
impairment(s), to do work-related activities, such as sitting, 
standing, walking, lifting, carrying, handling objects, hearing, 
speaking, and traveling; and, in cases of mental impairment(s), the 
opinion of the medical source about your ability to understand, to 
carry out and remember instructions, and to respond appropriately to 
supervision, coworkers and work pressures in a work setting. If you are 
a child, this statement should describe the opinion of the medical 
source about your functional limitations in learning, motor 
functioning, performing self-care activities, communicating, 
socializing, and completing tasks (and, if you are a newborn or young 
infant from birth to age 1, responsiveness to stimuli). Although we 
will ordinarily request, as part of the consultative examination 
process, a medical source statement about what you can still do despite 
your impairment(s), the absence of such a statement in a consultative 
examination report will not make the report incomplete. See 
Sec. 416.927; and
    (7) In addition, the medical source will consider, and provide some 
explanation or comment on, your major complaint(s) and any other 
abnormalities found during the history and examination or reported from 
the laboratory tests. The history, examination, evaluation of 
laboratory test results, and the conclusions will represent the 
information provided by the medical source who signs the report.
* * * * *
    (e) Signature requirements. All consultative examination reports 
will be personally reviewed and signed by the medical source who 
actually performed the examination. This attests to the fact that the 
medical source doing the examination or testing is solely responsible 
for the report contents and for the conclusions, explanations or 
comments provided with respect to the history, examination and 
evaluation of laboratory test results. The signature of the medical 
source on a report annotated ``not proofed'' or ``dictated but not 
read'' is not acceptable. A rubber stamp signature of a medical source 
or the medical source's signature entered by any other person is not 
acceptable.
    29. Section 416.919o is amended by revising the second sentence of 
paragraph (a) and the third sentence of paragraph (b) to read as 
follows:


Sec. 416.919o  When a properly signed consultative examination report 
has not been received.

* * * * *
    (a) When we will make determinations and decisions without a 
properly signed report. * * * After we have made the determination or 
decision, we will obtain a properly signed report and include it in the 
file unless the medical source who performed the original consultative 
examination has died.
* * * * *
    (b) When we will not make determinations and decisions without a 
properly signed report. * * * If the signature of the medical source 
who performed the original examination cannot be obtained because the 
medical source is out of the country for an extended period of time, or 
on an extended vacation, seriously ill, deceased, or for any other 
reason, the consultative examination will be rescheduled with another 
medical source.
* * * * *
    30. Section 416.919p is amended by revising paragraphs (b) and (c) 
to read as follows:


Sec. 416.919p  Reviewing reports of consultative examinations.

* * * * *
    (b) If the report is inadequate or incomplete, we will contact the 
medical source who performed the consultative examination, give an 
explanation of our evidentiary needs, and ask that the medical source 
furnish the missing information or prepare a revised report.
    (c) With your permission, or when the examination discloses new 
diagnostic information or test results that reveal potentially life-
threatening situations, we will refer the consultative examination 
report to your treating source. When we refer the consultative 
examination report to your treating source without your permission, we 
will notify you that we have done so.
* * * * *
    31. Section 416.919s is amended by revising paragraph (e)(2) and 
the first sentence of paragraph (f)(6) to read as follows:


Sec. 416.919s  Authorizing and monitoring the consultative examination.

* * * * *
    (e) * * *
    (2) Any consultative examination provider with a practice directed 
primarily towards evaluation examinations rather than the treatment of 
patients; or
* * * * *
    (f) * * *
    (6) Procedures for providing medical or supervisory approval for 
the authorization or purchase of consultative examinations and for 
additional tests or studies requested by consulting medical sources. * 
* *
* * * * *
    32. Section 416.927 is amended by revising the section heading, the 
third sentence of paragraph (d)(2), the heading of paragraph (e), 
paragraph (e)(2), the heading and introductory text of paragraph (f), 
and paragraph (f)(2), by adding a sentence to paragraph (d)(6), by 
adding introductory text to paragraph (e), and by adding paragraph 
(e)(3) to read as follows:


Sec. 416.927  Evaluating opinion evidence.

* * * * *
    (d) * * *
    (2) Treatment relationship. * * * When we do not give the treating 
source's opinion controlling weight, we apply the factors listed below, 
as well as the factors in paragraphs (d)(3) through (d)(6) of this 
section in determining the weight to give the opinion. * * *
* * * * *
    (6) Other factors. * * * For example, the amount of Social Security 
disability programs expertise an acceptable medical source has and 
whether an acceptable medical source reviewed the individual's entire 
case record before providing a medical opinion are relevant factors 
that we will consider in deciding the weight to give to a medical 
opinion.

[[Page 50280]]

    (e) Medical source opinions on issues reserved to the Commissioner. 
Opinions on some issues, such as the examples that follow, are not 
medical opinions, as described in paragraph (a)(2) of this section, but 
are, instead, opinions on issues reserved to the Commissioner because 
they are administrative findings that are dispositive of a case; i.e., 
that would direct the determination or decision of disability.
* * * * *
    (2) Other opinions on issues reserved to the Commissioner. We use 
medical sources, including your treating source, to provide evidence, 
including opinions, on the nature and severity of your impairment(s). 
Although we consider opinions from medical sources on issues such as 
whether your impairment(s) meets or equals the requirements of any 
impairment(s) in the Listing of Impairments in appendix 1 to subpart P 
of part 404 of this chapter, your residual functional capacity (see 
Secs. 416.945 and 416.946), or the application of vocational factors, 
the final responsibility for deciding these issues is reserved to the 
Commissioner.
    (3) We will not give any special significance to the source of an 
opinion on issues reserved to the Commissioner described in paragraphs 
(e)(1) and (e)(2) of this section.
    (f) Opinions of nonexamining sources. We consider all evidence from 
nonexamining sources to be opinion evidence. When we consider the 
opinions of nonexamining sources, we apply the rules in paragraphs (a) 
through (e) of this section. In addition, the following rules apply to 
State agency medical and psychological consultants, other program 
physicians and psychologists, and medical experts we consult in 
connection with administrative law judge hearings and Appeals Council 
review.
* * * * *
    (2) Administrative law judges are responsible for reviewing the 
evidence and making findings of fact and conclusions of law. They will 
consider opinions of State agency medical or psychological consultants, 
other program physicians and psychologists, and medical experts as 
follows:
    (i) Administrative law judges are not bound by any findings made by 
State agency medical or psychological consultants, or other program 
physicians or psychologists. However, State agency medical and 
psychological consultants and other program physicians and 
psychologists are highly qualified physicians and psychologists who are 
also experts in Social Security disability evaluation. Therefore, 
administrative law judges must consider findings of State agency 
medical and psychological consultants or other program physicians or 
psychologists, except for the ultimate determination about whether you 
are disabled. See Sec. 416.912(b)(6).
    (ii) When administrative law judges consider findings of State 
agency medical or psychological consultants or other program physicians 
or psychologists, they will evaluate the findings using relevant 
factors in paragraphs (a) through (e) of this section, such as the 
medical or psychological consultants', or other program physicians' or 
psychologists', medical specialty and expertise in our rules, the 
evidence reviewed by the consultants or other program physicians or 
psychologists, supporting explanations provided by the consultants or 
other program physicians or psychologists, and any other factors 
relevant to the weighing of the opinions. The administrative law judge 
must explain in the decision the weight given to the opinions of a 
State agency medical or psychological consultant or other program 
physician or psychologist, as the administrative law judge must do for 
any opinions from treating sources, nontreating sources, and 
nonexamining sources who do not work for us.
    (iii) Administrative law judges may also ask for and consider 
opinions from medical experts on the nature and severity of your 
impairment(s) and on whether your impairment(s) equals the requirements 
of any impairment listed in appendix 1 to subpart P of part 404 of this 
chapter. When administrative law judges consider these opinions, they 
will evaluate them using the rules in paragraphs (a) through (e) of 
this section.
* * * * *
[FR Doc. 97-25366 Filed 9-24-97; 8:45 am]
BILLING CODE 4190-29-U