[Federal Register Volume 65, Number 45 (Tuesday, March 7, 2000)]
[Rules and Regulations]
[Pages 11866-11881]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-5035]


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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: Final rules.

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SUMMARY: We are revising the Social Security and Supplemental Security 
Income (SSI) regulations concerning 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 are also defining and 
clarifying several terms used in our regulations and deleting other 
terms.

EFFECTIVE DATE: These rules are effective April 6, 2000.

FOR FURTHER INFORMATION CONTACT: Georgia E. Myers, Acting Regulations 
Officer, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, 1-410-965-3632, or TTY 1-800-966-5609. For 
information on eligibility or filing for benefits, call our national 
toll-free number, 1-800-772-1213, or TTY 1-800-325-0778.

SUPPLEMENTARY INFORMATION: The Act provides, in title II, for the 
payment of

[[Page 11867]]

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 disability, ``disability'' means that 
an impairment(s) causes ``marked and severe functional limitations.'' 
(Our regulations explain at Sec. 416.902 that ``Marked and severe 
functional limitations, when used as a phrase, * * * is a level of 
severity that meets or medically or functionally equals the severity of 
a listing in the Listing of Impairments in appendix 1 of subpart P of 
part 404 * * *.'') 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 Revisions

Simplification and Clarification of Terms

    These final regulations define and clarify several terms that have 
been used in our regulations, and delete other terms. Our prior 
regulations used several terms to refer to sources of medical evidence. 
Regulations Secs. 404.1502 and 416.902, ``General definitions and terms 
for this subpart,'' defined the terms ``source of record,'' ``medical 
sources'' (which included ``consultative examiners''), and ``treating 
source.'' These terms were 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 
used the phrase ``a treating physician or psychologist, another source 
of record, or an independent source.'' Regulations Secs. 404.1527 and 
416.927 also employed 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 that are 
acceptable medical sources. We need various terms for types of 
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 evidence but who have not 
treated or examined the individual).
    Therefore, while the term ``medical source'' includes the term 
``acceptable medical source,'' we are simplifying and clarifying the 
specific 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 
Secs. 404.1527(a)(2) and 416.927(a)(2)) and other opinions (e.g., 
opinions on issues reserved to the Commissioner of Social Security (the 
Commissioner)--see 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 
includes all three types of sources. These clarifications do not change 
our current policy, but are only intended to clarify our intent.
    To do this, we now 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 are also redefining 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. 
We are deleting speech and language pathologist from this example, 
which appeared in the Notice of Proposed Rulemaking (NPRM), published 
in the Federal Register on September 25, 1997 (62 FR 50271), because an 
NPRM published October 9, 1998 (63 FR 54417) proposes to add qualified 
speech and language pathologists as acceptable medical sources.
    In addition, a distinction between ``medical source'' and 
``acceptable medical source'' is necessary because ``an acceptable 
medical source'' is required to establish the existence of a medically 
determinable impairment. See Secs. 404.1513(a) and 416.913(a). Also, 
only an ``acceptable medical source'' can be considered to be a 
``treating source'' for purposes of giving controlling weight to 
treating source medical opinion. See Sec. 404.1527(d)(2) and 
416.927(d)(2). The distinction between ``acceptable medical source'' 
and ``medical source'' is simply to facilitate application of the two 
longstanding rules noted above and is in no way intended to imply 
anything derogatory about medical sources that are not ``acceptable 
medical sources.''
    We are also adding definitions for the terms ``nonexamining 
source'' and ``nontreating source,'' which have been used in 
Secs. 404.1527 and 416.927, but which previously were not defined in 
our regulations. We are clarifying 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 and 
licensed or certified psychologists, and, consistent with the use of 
the word ``evaluation'' in the first sentence of the 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 are deleting the term ``source of record'' because sources 
previously included in the definition of that term are now included in 
the definition of the terms ``acceptable medical source'' or ``medical 
sources,'' and the term ``source of record'' is not needed.

Clarification of Secs. 404.1527 and 416.927

    Consistent with our original intent, we are clarifying paragraph 
(f) of Secs. 404.1527 and 416.927. As we explained in the preamble to 
the 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 and Appeals

[[Page 11868]]

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 regulations have stated 
since 1991 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 restated and clarified 
these provisions of the regulations in Social Security Ruling 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 preamble to the regulations 
published in 1991 and in Social Security Ruling 96-6p, we are making 
the following revisions to paragraph (f) of Secs. 404.1527 and 416.927. 
We are also making conforming revisions to paragraphs (d)(6) and (e). 
None of these revisions changes 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, it is 
inaccurate to refer in paragraph (f) solely to opinions on the ``nature 
and severity of a person's impairment(s).'' Therefore, we are deleting 
the phrase ``on the nature and severity of your impairments'' from the 
introductory text of paragraph (f). We are also revising 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. We have divided paragraph (f)(2) into an 
introductory paragraph and new paragraphs (f)(2)(i) through 
(f)(2)(iii), which 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), now include reference to ``other program physicians and 
psychologists'' and the term ``medical expert'' for consistency with 
the language in paragraph (b)(6) of Secs. 404.1512 and 416.912.
    We are clarifying in new paragraph (f)(2)(i) of Secs. 404.1527 and 
416.927 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 administrative law judges make their decisions. We now 
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) of Secs. 404.1527 and 416.927 we are also 
providing 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 are also clarifying 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. We have added language that did not appear in 
the NPRM (see 62 FR 50272, September 25, 1997) to clarify that when 
treating source opinion is given controlling weight, it is not 
necessary for the administrative law judge to provide an explanation of 
the weight given to the opinion of a State agency medical or 
psychological consultant. For purposes of clarity, we have also made a 
revision to the first sentence of paragraph (f)(2)(ii) to refer to 
administrative law judges in the singular, rather than the plural.
    In new paragraph (f)(2)(iii) of Secs. 404.1527 and 416.927, we are 
substituting the term ``medical expert'' for ``medical advisor'' for 
the reason explained below in the discussion of Secs. 404.1512 and 
416.912. We are also making it clear in new paragraph (f)(2)(iii) of 
Secs. 404.1527 and 416.927 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 are also amending 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. One example of a relevant factor that we 
proposed in the proposed rules to add to Secs. 404.1527(d)(6) and 
416.927(d)(6) was the amount of Social Security disability program 
expertise an acceptable medical source has. However, as a result of 
public comments received on this proposed example, we are revising the 
example to give consideration to the amount of understanding that an 
acceptable medical source has of our disability programs and their 
evidentiary requirements, regardless of the source of that 
understanding, as a relevant factor that is consistent with the 
examples in final paragraph (f)(2)(ii). This includes acceptable 
medical sources that are current or former State agency medical or 
psychological consultants and other program physicians and 
psychologists. This also includes those acceptable medical sources that 
have gained their understanding of our disability programs and their 
evidentiary requirements in other ways (e.g., through continuing 
medical education or experience in conducting consultative examinations 
for us).
    Another example of a relevant factor that we proposed to add was 
whether an acceptable medical source reviewed the individual's entire 
case record. However, based on the public comments received on this 
proposed example, we are revising the example to provide that the 
extent to which an acceptable medical source is familiar with the other 
information in the individual's case record is a relevant factor. Both 
of these are examples of relevant factors that we will consider in 
deciding the weight to give to a medical opinion from any acceptable 
medical source.
    We are also amending 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 final paragraph (e)(3) to 
make it clear that the rule in new final paragraph (e)(3) applies to an

[[Page 11869]]

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 are clarifying, consistent with 
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.
    We are deleting reference to the ``Secretary'' from Sec. 416.902 to 
reflect Sec. 702(a)(5) of the Social Security Act as amended by 
Sec. 102 of the Social Security Independence and Program Improvements 
Act of 1994, Public Law 103-296, enacted on August 15, 1994, which 
transferred from the Secretary of Health and Human Services to the 
Commissioner of Social Security the authority to issue regulations. We 
are revising the language from how it appeared in the NPRM (62 FR 
50272, September 25, 1997) to clarify the change in authority from the 
Secretary of Health and Human Services to the Commissioner.

Sections 404.1512 and 416.912 Evidence of Your Impairment

    We are amending 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 of 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 are also changing 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 are revising 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 Social Security Ruling 96-6p, 61 FR 34466, 34468.)
    The regulations describe two distinct kinds of assessments of what 
an individual can do despite the presence of a severe impairment(s). 
The first is described in Secs. 404.1513(b) and (c) as a ``statement 
about what you can still do despite your impairment(s)'' made by an 
individual's medical source and based on that source's own medical 
findings. This ``medical source statement'' is an opinion submitted by 
a medical source as part of a medical report. The second category of 
assessments is the residual functional capacity assessment described in 
Secs. 404.1545, 404.1546, 416.945, and 416.946 which is the 
adjudicator's ultimate finding of ``what you can still do despite your 
limitations.'' Even though the adjudicator's residual functional 
capacity assessment may adopt the opinions in a medical source 
statement, they are not the same thing. A medical source statement is 
evidence that is submitted to the Social Security Administration (SSA) 
by an individual medical source reflecting the source's opinion based 
on his or her own knowledge, while a residual functional capacity 
assessment is the adjudicator's ultimate finding based on a 
consideration of this opinion and all the other evidence in the case 
record about what an individual can do despite his or her 
impairment(s). (See Social Security Ruling SSR 96-5p).
    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 are clarifying 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 are also clarifying 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

    For the reasons explained above about the definition of the term 
``treating source,'' we are revising the first sentence of 
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 ``independent source.''

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

    We are revising paragraph (a) of these sections 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 revised definition of ``medical source'' in Secs. 404.1502 and 
416.902. For the same reason, we are also changing the phrase 
``physician or psychologist'' in the first sentence of paragraph (c) to 
``medical source.''

Sections 404.1519h and 416.919h  Your Treating Source

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

Sections 404.1519j and 416.919j Objections to the Medical Source 
Designated To Perform the Consultative Examination.

    We are revising 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 are revising 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 are revising the first sentence of these sections to substitute 
the term ``treating source'' for the term ``treating physician or 
psychologist.'' We are also revising the last sentence to use the term 
``medical source designated to perform the consultative examination,'' 
rather than the phrase ``consultative examining

[[Page 11870]]

physician or psychologist,'' for the reasons explained above.

Sections 404.1519n and 416.919n Informing the Medical Source of 
Examination Scheduling, Report Content, and Signature Requirements

    We are revising the heading, introductory paragraph, and paragraphs 
(a), (b), (c), and (e) of these sections to use the term ``medical 
source,'' rather than the phrase ``physician or psychologist,'' for the 
reasons explained above. We are deleting the word ``examining'' from 
the previous regulations and NPRM because sources that examine or have 
examined a claimant are included in the new definition of the term 
``medical source.'' We are also adding a heading to paragraph (a) for 
consistency with the other paragraphs in this section. In addition, we 
are revising paragraph (c)(6) to insert language that we originally 
intended to include in the 1991 regulations ``Standard for Consultative 
Examinations and Existing Medical Evidence'', as explained in our 
statements in the preamble to those regulations (56 FR 36932, 36934, 
August 1, 1991), 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 are revising paragraphs (a) and (b) of these sections 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 are revising paragraph (b) of these sections to use the term 
``medical source,'' rather than the phrase ``physician or 
psychologist,'' for the reasons explained above. We are revising 
paragraph (c) to correct the grammar in the first sentence by 
substituting the word ``when'' for the word ``where.'' We are also 
substituting the term ``treating source'' for the term ``treating 
physician or psychologist.''

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

    We are revising paragraph (e)(2) of these sections 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 now use the term ``medical sources'' in paragraph 
(f)(6), rather than the phrase ``physicians and psychologists.''

Sections 404.1527 and 416.927  Evaluating Opinion Evidence

    We are changing 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 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 are revising 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 introductory text to 
Secs. 404.1527(d) and 416.927(d), exclusion of reference to paragraph 
(d)(6) was an inadvertent omission when the rule was published. (56 FR 
36932, August 1, 1991.)
    We are changing 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 are also changing 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 are also shortening the heading of paragraph (f) of 
Secs. 404.1527 and 416.927 to ``Opinions of nonexamining sources,'' 
consistent with the definitions in Secs. 404.1502 and 416.902. For the 
same reason, we are substituting the term ``nonexamining sources'' for 
``nonexamining physicians and psychologists'' in the first sentence of 
paragraph (f).

Public Comments

    We published these regulatory provisions in the Federal Register as 
an NPRM on September 25, 1997 (62 FR 50270), and we provided the public 
with a 60-day comment period. The comment period closed on November 24, 
1997. We received comments in response to this notice from 126 
individuals and organizations. The commenters included Government 
agencies whose interests and responsibilities require them to have some 
expertise in the evaluation of medical evidence used in making 
disability determinations under titles II and XVI of the Act. They also 
included individuals with disabilities, support groups for individuals 
with disabilities, attorneys and non-attorney representatives, and 
legal services organizations that represent the interests of 
individuals with disabilities. In addition, we received comments from 
one medical association, physicians, and other medical professionals.
    Because many of the comments were detailed, we condensed, 
summarized, or paraphrased them. We have tried to summarize the 
commenters' views accurately and to respond to all of the significant 
issues raised by the commenters that are within the scope of these 
rules.
    Comment: One commenter recommended that the deadline for submission 
of comments on the proposed rules be extended, noting that the 
evaluation of opinion evidence is central to the determination of 
disability, and that the length and complexity of the proposed rules 
made comments on the proposed changes extremely difficult.
    Response: The NPRM provided the 60-day period that is generally 
provided for public comments on a proposed rule. We considered the 
recommendation to extend this period; however, we decided that this was 
not necessary in view of the number of comments received within the 60-
day period displaying in-depth review and consideration of the proposed 
rules. Moreover, we did not propose any revisions that would change our 
policies on the evaluation of opinion evidence, and most of the 
revisions in the

[[Page 11871]]

proposed rules merely improved the consistency of our terminology 
throughout the regulations.
    Comment: Many of the comments concerned the quality of consultative 
examinations we purchase, including the qualifications of consultative 
examiners and support staff, their equipment, treatment of claimants, 
and the time spent in conducting some consultative examinations.
    Response: Although these comments were outside the scope of the 
proposed rules, the quality of the consultative examinations we 
purchase is important to us, and we will consider the comments as we 
work with the State agencies to ensure quality examinations. We take 
very seriously our responsibility to do so, as outlined in 
Secs. 404.1519 ff. and 416.919 ff. However, as we explain above, we are 
revising the paragraphs in Secs. 404.1519 ff. and 416.919 ff. only to 
substitute the term ``medical source'' for the phrase ``physician or 
psychologist'' and to make minor technical revisions. We are not making 
substantive changes to the rules stated in Secs. 404.1519 ff. and 
416.919 ff. concerning the purchase of consultative examinations and 
the review of consultative examination reports to ensure the quality 
and appropriateness of the examinations.
    Comment: Many commenters questioned our statement in 
Secs. 404.1527(f)(2) and 416.927(f)(2) of the proposed rules that State 
agency medical and psychological consultants are highly qualified 
physicians and psychologists who are also experts in Social Security 
disability evaluation, contending that this was an effort to introduce 
a new criterion to give more weight to the opinions of the State agency 
medical and psychological consultants. A number of other commenters 
observed that the statement of findings by the State agency physicians 
and psychologists are part of the disability determination at the 
initial and reconsideration levels of administrative review, and they 
questioned how findings made at one level by an agency adjudicator 
become expert opinion evidence at another level on the same case. One 
commenter also indicated that the use of the findings by an adjudicator 
at one level of administrative review as expert witness evidence at 
another level represents a conflict of interest.
    Response: The statement in Secs. 404.1527(f)(2) and 416.927(f)(2) 
of the proposed rules was taken from the preamble to the original 
publication of these rules in 1991. (``Standard for Consultative 
Examinations and Existing Medical Evidence'' (56 FR 36937, August 1, 
1991)). Therefore, it is not a new criterion, only a clarification in 
the regulations of our original intent. As noted in the 1991 preamble, 
``* * * State agency medical and psychological consultants are highly 
qualified physicians and psychologists who are also experts in Social 
Security disability evaluation. Therefore, it has been our longstanding 
policy that administrative law judges will consider the findings of 
State agency medical and psychological consultants with regard to the 
nature and severity of a claimant's impairment as opinions of 
nonexamining physicians and psychologists.'' (56 FR 36937, August 1, 
1991). We restated and clarified this policy in Social Security Ruling 
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.) However, and as is 
discussed in more detail later in this preamble, when an administrative 
law judge or the Appeals Council considers the opinion of a State 
agency medical or psychological consultant, the weight that will be 
given to the opinion will depend on the degree to which the medical or 
psychological consultant provides a supporting explanation for the 
opinion.
    These revisions do not represent a change in policy. It has been 
our longstanding policy that findings made by State agency medical and 
psychological consultants are considered opinion evidence at the 
hearing and Appeals Council levels. Since 1991, Secs. 404.1527(f) and 
416.927(f) have required administrative law judges and the Appeals 
Council to consider those findings of fact about the nature and 
severity of an individual's impairment(s) as opinion evidence of 
nonexamining physicians and psychologists. These requirements are based 
on the medical or psychological consultants' experience as health care 
professionals who are also experts in the evaluation of the medical 
issues in disability claims under the Act and recognize that we weigh 
medical opinions included in case records.
    In response to the last commenter, the consideration of findings 
made by a State agency medical or psychological consultant at the 
initial or reconsideration level of administrative review as opinion 
evidence at the hearing level does not represent a conflict of 
interest. At the hearing level, administrative law judges consider the 
issues before them de novo. Therefore, when administrative law judges 
consider issues of disability, they are not bound by any findings made 
at the State agency in connection with the initial and reconsidered 
determinations.
    Comment: Many of the commenters expressed a concern that the intent 
of the proposed rules was to negate or moderate the rules for weighing 
opinion evidence from treating sources that recognize the special 
intrinsic value of a treating source's relationship with the 
individual. In particular, concern was expressed about the revision to 
Secs. 404.1527(d)(6) and 416.927(d)(6) that added two examples of other 
factors that can affect the weight we give to a medical opinion from an 
acceptable medical source. The two factors noted were the amount of 
Social Security disability programs expertise the acceptable medical 
source has, and whether the acceptable medical source reviewed the 
individual's entire case record before providing a medical opinion.
    Response: It was not and is not our intent to negate or moderate 
the rules for weighing opinions from treating sources. We continue to 
provide in Secs. 404.1527(d) and 416.927(d) that ``Generally we give 
more weight to opinions from your treating sources, since these sources 
are likely to be the medical professionals most able to provide a 
detailed, longitudinal picture of your medical impairment(s) and may 
bring a unique perspective to the medical evidence that cannot be 
obtained from the objective medical findings alone or from reports of 
individual examinations, such as consultative examinations or brief 
hospitalizations.'' We also continue to provide that we will give 
treating source medical opinions on the nature and severity of an 
impairment ``controlling weight'' if we find that the opinion is well-
supported by medically acceptable clinical and laboratory diagnostic 
techniques and is not inconsistent with the other substantial evidence 
in the case record. As we explain above, the two examples being added 
to paragraph (d)(6) of Secs. 404.1527 and 416.927 are simply examples 
of factors that can affect the weight we give a medical opinion. We 
believe that they are valid considerations along with all of the other 
factors (including treatment relationship) we consider when we weigh 
medical opinions. In response to public comments, however, we are 
revising the two examples that appeared in the NPRM. We are revising 
the first example to give consideration to the amount of understanding 
that an acceptable medical source has of our

[[Page 11872]]

disability programs and their evidentiary requirements, regardless of 
the source of that understanding. We are revising the second example to 
provide that the extent to which an acceptable medical source is 
familiar with the other information in the individual's case record is 
a relevant factor that we will consider.
    Comment: Many commenters questioned why we proposed to add a rule 
to Secs. 404.1527(d) and 416.927(d) to consider the amount of Social 
Security disability programs expertise an acceptable medical source 
has. They expressed the opinion that, with few exceptions, State agency 
medical and psychological consultants will be the only medical sources 
with experience working with the disability program. Another commenter 
argued that medical experts should be treated as experts because of 
their knowledge of medicine, not their knowledge of the law. One 
commenter asked what ``disability program expertise'' is and how it 
would be measured. Another commenter stated that a medical source's 
expertise on the subject of a particular individual's impairments or 
limitations should be evaluated based on his or her knowledge of the 
individual and the type of medical impairment experienced by the 
individual, not by his or her knowledge of the Social Security law and 
regulations.
    Response: As we indicated in the preamble to the proposed rules on 
September 25, 1997 (62 FR 50272), we proposed to list an acceptable 
medical source's ``Social Security disability programs expertise'' as 
an example of the ``other factors'' referenced in Secs. 404.1527(d)(6) 
and 416.927(d)(6) that we will consider in weighing an acceptable 
medical source's medical opinion. As indicated in the preamble, 
exclusion of the reference to paragraph (d)(6) was an inadvertent 
omission when the rules on consideration of medical evidence were 
published in 1991. However, we did not intend that an employment or 
contractual relationship with SSA or a State agency as a medical or 
psychological consultant would be the sole means to obtain ``Social 
Security disability programs expertise.'' We agree that there will be 
acceptable medical sources that have never been in such a relationship 
with SSA who will have developed expertise in Social Security 
disability programs. For example, some medical sources will have 
obtained such expertise through continuing medical education, or as a 
result of conducting consultative examinations for us. (See 
Secs. 404.1519n and 416.919n, which state that the ``medical sources 
who perform consultative examinations will have a good understanding of 
our disability programs and their evidentiary requirements.'') 
Therefore, we are revising Secs. 404.1527(d)(6) and 416.927(d)(6) 
further to delete ``Social Security disability programs expertise'' as 
an example of the ``other factors'' reference in Secs. 404.1527(d)(6) 
and 416.927(d)(6), and to add the amount an acceptable medical source's 
``understanding of our disability programs and their evidentiary 
requirements'' as an example of one of the factors we will consider in 
weighing the acceptable medical source's medical opinion, regardless of 
the source of that understanding.
    Comment: A number of commenters expressed a concern that 
nonexamining State agency medical and psychological consultants may not 
have an understanding of ``emerging illnesses,'' such as Chronic 
Fatigue Syndrome, fibromyalgia, multiple chemical sensitivities, or 
lupus erythematosus. Several of these commenters indicated, as well, 
that many regular treating sources do not have the understanding of 
these illnesses that private researchers and specialists do, and that 
more weight should be given to the opinions of those specialists who 
are treating an individual for these illnesses.
    Response: We believe that the regulations take this concern into 
account. The regulations provide for a variety of factors to be applied 
in evaluating medical opinions, depending on the facts of the 
individual case. For example, Secs. 404.1527(d)(5) and 416.927(d)(5) 
state that ``We generally give more weight to the opinion of a 
specialist about medical issues related to his or her area of specialty 
than to the opinion of a source who is not a specialist.'' Therefore, 
when we do not give the treating source's opinion controlling weight 
(for example if a specialist submits evidence that is inconsistent with 
the treating source's opinion), we can give more weight in an 
appropriate case to the opinion of a specialist on the individual's 
particular medical impairment. As we have already noted, the weight to 
which a medical or psychological consultant's opinion will be entitled 
depends on these same factors.
    Comment: One commenter noted that giving weight to Social Security 
program expertise and review of the entire case file and requiring 
administrative law judges to explain in the decision the weight given 
to the opinions of a State agency medical or psychological consultant 
reinforces the basic tenets of Process Unification. Another commenter 
elaborated on this point, noting that the revision to Secs. 404.1527 
and 416.927 clarifying our longstanding policy that administrative law 
judges must consider State agency medical and psychological consultant 
findings as opinion evidence is an important step in Social Security's 
efforts to unify the disability process and to restore the program's 
credibility with the public. The commenter noted that two different 
processes are perceived now, the initial/reconsideration process in the 
State agency and the administrative law judge hearing.
    Response: As the commenters have observed, these revisions are part 
of our current Process Unification initiative, which is intended to 
achieve similar and correct results on similar cases at all stages of 
the administrative review process for claims for disability benefits 
under the Act, by ensuring that decisionmakers at each stage are 
following consistent policies in deciding these claims. This is 
expected to result in the allowance of claims that should be allowed at 
the earliest possible level of administrative review, potentially 
providing favorable decisions at an earlier point for disabled 
claimants, as well as reducing both the rate of appeal and the rate of 
allowance on appeal for these claims.
    Comment: A number of commenters believed that expertise in Social 
Security's rules is not something that can be presumed; the expertise 
of the individual nonexamining doctor would need to be proven in every 
case in which this factor is an issue. These comments noted that, at 
the very least, claimants and their representatives must be provided 
with documentation of the qualifications, training, and expertise of 
the State agency medical sources.
    Response: The Act and regulations recognize State agency medical 
and psychological consultants as experts in Social Security disability 
programs. The rules in Secs. 404.1527(f) and 416.927(f) require 
administrative law judges and the Appeals Council to consider the State 
agency consultants' findings of fact about the nature and severity of 
an individual's impairment(s) as opinions of nonexamining physicians 
and psychologists. When an administrative law judge admits a medical 
opinion into the case record as an exhibit for consideration, including 
a medical opinion from a State agency medical or psychological 
consultant that was considered a finding at any earlier level in the 
administrative review process, the administrative law judge will also 
admit into the record a statement of the medical source's professional

[[Page 11873]]

qualifications as required by our operating instructions.
    Comment: A number of commenters questioned why we proposed to add 
an example to Secs. 404.1527(d) and 416.927(d) indicating that whether 
an acceptable medical source reviewed the entire case before providing 
a medical opinion is a relevant factor to be considered in evaluating 
the source's medical opinion. They also questioned whether medical 
sources other than State agency medical and psychological consultants 
will have an opportunity to review the individual's entire case record 
before they provide a medical opinion.
    One State agency commenter fully supported the value of a complete 
file review when assigning weight to medical opinions, noting that 
medical opinions are too often given adjudicative weight that may be 
countered by objective evidence or other expert opinion evidence 
elsewhere in the file.
    Response: As with the example of an acceptable medical source's 
``understanding of our disability programs and their evidentiary 
requirements,'' we are revising this proposed example and listing 
whether the acceptable medical source is familiar with the other 
information in the individual's case record as another example of the 
``other factors'' referenced in Secs. 404.1527(d)(6) and 416.927(d)(6) 
that we will consider in weighing an acceptable medical source's 
medical opinion. We believe that it is appropriate for the adjudicator 
to consider whether an acceptable medical source is familiar with the 
other information in the individual's case record because this is a 
relevant factor that can properly affect the weight we give to a 
medical opinion. An individual and his or her representative have a 
right to review and obtain copies of the materials in the individual's 
case record, e.g., for review by the individual's treating or other 
medical source, if this should be desired.
    Comment: One commenter noted that it is the practice for 
administrative law judges to require ``fresh'' evidence, and thus 
current evidence will be submitted just weeks prior to the hearing. The 
commenter noted that whatever evidence was available to the State 
agency medical or psychological consultant would not be current and 
that the administrative law judge would consider the additional 
evidence.
    Response: We agree that the record before the administrative law 
judge will often include additional evidence beyond what the State 
agency medical or psychological consultant considered in his or her 
medical opinion. As the example in paragraph (d)(6) of Secs. 404.1527 
and 416.927 indicates, concerning whether an acceptable medical source 
is familiar with the other information in the individual's case record, 
this factor will be considered when the administrative law judge or 
Appeals Council weighs medical opinions from a State agency medical or 
psychological consultant or other acceptable medical source. This may 
limit the weight that can be given to a medical opinion from a State 
agency medical or psychological consultant and the period to which the 
opinion applies.
    Comment: A number of commenters indicated their concern with the 
manner in which a State agency medical or psychological consultant's 
medical opinion may be provided in the record. Some of the commenters 
noted that these opinions frequently are expressed as boxes checked on 
a form, with little or no rationale, or as a statement of medical 
findings from records in the file with no other explanation for why the 
residual functional capacity assessment provided would flow from these 
findings, or why these opinions from State agency medical or 
psychological consultants are in conflict with the opinions of treating 
or examining physicians. They noted that there is no reasonable basis 
for giving further weight to such a cursory report lacking a 
substantive rationale.
    Response: The revisions we are making do not represent a change in 
our longstanding policy that the adjudicator should give little weight 
to an opinion from any source, including a State agency medical or 
psychological consultant, that is poorly explained and not supported by 
the evidence in the record. Sections 404.1527(d)(3) and 416.927(d)(3) 
have stated and continue to state: ``The better an explanation a source 
provides for an opinion, the more weight we will give that opinion. 
Furthermore, because nonexamining sources have no examining or treating 
relationship with you, the weight we give their opinions will depend on 
the degree to which they provide supporting explanations for their 
opinions.'' We will evaluate the degree to which these opinions 
consider all of the pertinent evidence in your claim, including 
opinions of treating and other medical sources.
    Comment: A number of commenters believed that the claimant has a 
right to cross-examine the State agency medical or psychological 
consultant when his or her opinions become evidence to be considered by 
an administrative law judge. Some of the commenters noted that 
administrative law judges have been reluctant to issue subpoenas for 
State agency medical or psychological consultants to testify, 
presumably because this would interfere with the State agency's ability 
to process disability claims in a timely and efficient manner. Some of 
the attorneys and other claimants' representatives who commented stated 
their belief that they would have to increase their requests for 
subpoenas if administrative law judges consider State agency medical 
and psychological consultant opinions in their decisions.
    Response: The revisions we are making do not represent a change in 
policy. Sections 404.1527(f) and 416.927(f) of the regulations have 
stated since 1991 that medical opinions from State agency medical and 
psychological consultants are considered by administrative law judges 
and the Appeals Council, and we restated and clarified these provisions 
of the regulations in Social Security Ruling 96-6p in 1996. We do not 
anticipate that these final rules will increase the instances in which 
a claimant would wish to compel a State agency medical or psychological 
consultant to appear and testify (or to amplify his or her opinion 
through a voluntary appearance or responses to interrogatories.) These 
final rules also do not change the standards in our regulations under 
which administrative law judges determine whether to issue subpoenas. 
Paragraph (d)(1) of Secs. 404.950 and 416.1450 states that 
administrative law judges may issue subpoenas in those situations 
``[w]hen it is reasonably necessary for the full presentation of a 
case.'' Paragraph (d)(2) provides that parties to a hearing may request 
a subpoena to compel testimony or documents, providing they file a 
written request with the administrative law judge at least 5 days 
before the hearing date. This request must justify the need for a 
subpoena by stating the ``important facts that the witness or document 
is expected to prove'' and by indicating ``why these facts could not be 
proven without issuing a subpoena.''
    Comment: Two commenters expressed concern regarding our 
clarification in Secs. 404.1502 and 416.902 of the term ``medical 
source'' and the concept of a ``qualified medical source,'' when these 
terms are used in Secs. 404.1519g and 416.919g in discussing the 
purchase of consultative examinations. They agreed that in many 
situations an audiologist may be the appropriate source to perform a 
consultative examination, but questioned whether the proposed rules are 
clear on whether other sources such as chiropractors or social workers 
are

[[Page 11874]]

also appropriate sources to perform these examinations.
    Response: As we explain above, and as we explained in the preamble 
to the NPRM in discussing the amendments to Secs. 404.1502 and 416.902 
(62 FR 50270), 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. As Secs. 404.1519g(b) and 416.919g(b) provide, by 
``qualified'' we mean that the medical source must be currently 
licensed in the State and have the training and experience to perform 
the type of examination or test we will request; the medical source 
must not be barred from participation in our program under the 
provisions of Secs. 404.1503a and 416.903a; and the medical source must 
also have the equipment required to provide an adequate assessment and 
record of the existence and level of severity of the claimant's alleged 
impairments. Any medical source, which can include a chiropractor or 
social worker, that meets the requirements for being ``qualified'' 
under Secs. 404.1519g and 416.919g may be an appropriate source to 
conduct a consultative examination.
    Comment: One commenter questioned our inclusion of psychologists as 
``acceptable medical sources.'' The commenter noted that psychologists 
do not have medical training, they are not licensed to practice 
medicine, and they do not provide medical treatment. The commenter 
proposed that we use the term ``medical and psychological sources'' 
whenever we refer to physicians and psychologists under the same 
heading, as we use the phrase ``medical and psychological consultants'' 
in these regulations. The commenter also questioned our use of the term 
``medical expert'' to include physicians and psychologists, and 
proposed that we substitute the terminology ``medical experts or 
psychologists'' for all references to ``medical experts.''
    Response: ``Licensed or certified psychologists'' have been 
included in the list of ``acceptable medical sources'' in 
Secs. 404.1513(a) and 416.913(a) since 1980, and their continuing 
inclusion does not represent a change in policy. (45 FR 55567, 55587, 
55623, August 20, 1980.) In addition, the Act [42 U.S.C. 421], as well 
as Secs. 404.1503(e) and 416.903(e) of the regulations, require that in 
initial determinations that the claimant is not disabled, and there is 
evidence that indicates the existence of a mental impairment, every 
reasonable effort should be made to ensure that a qualified 
psychiatrist or psychologist has completed the medical portion of the 
case review and any applicable residual functional capacity assessment. 
Also, as we explain above, we are now changing the term ``medical 
advisor'' to ``medical expert'' in Secs. 404.1512(b)(6) and 
416.912(b)(6) and elsewhere, 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. We previously used 
the term ``medical advisor'' for many years in Secs. 404.1512(b)(6) and 
416.912(b)(6). This change in terminology does not represent a change 
in policy.
    Comment: A number of commenters expressed concern that the proposed 
clarification in the definition of ``medical source'' in Secs. 404.1502 
and 416.902 to include ``acceptable medical sources or other health 
care providers who are not acceptable medical sources,'' would 
prejudice the weighing of evidence from medical sources who are not 
``acceptable medical sources.'' These commenters note that many 
claimants do not, or cannot, receive their primary treatment from 
``acceptable medical sources,'' and the nature and frequency of their 
treatment or evaluation is more a function of staff or time 
availability, rather than the need for treatment. For example, many 
claimants receive their primary mental health treatment from therapists 
or social workers with only monthly visits with a physician for 
medication control. They note that the existing and the proposed rules 
exclude such sources from consideration as ``treating sources.''
    Response: As the commenters note, we have now provided a definition 
of the term ``acceptable medical source'' in Secs. 404.1502 and 416.902 
by reference to Secs. 404.1513(a) and 416.913(a), where the sources who 
are ``acceptable medical sources'' have been identified for many years. 
These sources have the training and experience necessary to provide the 
medical evidence that is required by the Act and these regulations to 
establish the existence of a medically determinable impairment or 
impairments. We recognize, however, that some individuals receive 
treatment from other sources, and our longstanding policy stated in 
Secs. 404.1513(e) and 416.913(e) is to use information from these other 
sources, such as social welfare agencies, to help us to understand how 
an individual's impairment may affect his or her ability to work, once 
the existence of a medically determinable impairment has been 
established.
    Comment: One commenter agreed with the clarification in 
Secs. 404.1502 and 416.902 that a source that only examines and 
evaluates an individual on an ongoing basis, but who does not provide 
any treatment, may also be a ``treating source.'' The commenter noted 
that many of the individuals making a claim for disability benefits do 
not have private insurance or resources to pay for medical care and 
must rely on the local public health care system, and many times the 
only ``treatment'' the public health care services provide for people 
with chronic physical or mental ailments are periodic examinations and 
evaluations.
    Response: As the commenter has noted, we are clarifying the 
definition of ``treating source'' in Secs. 404.1502 and 416.903 to be 
consistent with our longstanding use of the word ``evaluation'' in the 
definition of a ``treating source'' as a source ``who has provided you 
with medical treatment or evaluation * * *.''

Regulatory Procedures

Executive Order 12866

    We have consulted with the Office of Management and Budget (OMB) 
and determined that these final rules do not meet the criteria for a 
significant regulatory action under Executive Order 12866. Therefore, 
they were not subject to OMB review. We have also determined that these 
rules meet the plain language requirement of Executive Order 12866 and 
the President's memorandum of June 1, 1998.

Regulatory Flexibility Act

    We certify that these 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 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

[[Page 11875]]

Insurance, Reporting and recordkeeping requirements, Social security.

20 CFR Part 416

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

    Dated: February 14, 2000.
Kenneth S. Apfel,
Commissioner of Social Security.

    For the reasons set out in the preamble, subpart P of part 404 and 
subpart I of part 416 of 20 CFR chapter III are amended 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 republishing the introductory 
text, removing the terms ``Source of record'' and ``you,'' revising the 
definitions of ``Medical sources'' and ``Treating source,'' and adding 
definitions in the appropriate alphabetical order for the terms 
``Acceptable medical source,'' ``Nonexamining source,'' ``Nontreating 
source,'' and ``you or your'' 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 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 as follows (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. * * *

[[Page 11876]]


    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 medical 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 text 
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 medical source 
designated to perform the consultative examination.

    12. Section 404.1519n is amended by revising the section heading 
and the first and last sentences of the introductory text, adding a 
heading to paragraph (a), revising the first sentence of paragraph (a) 
introductory text, revising the last two sentences of paragraph (b), 
revising the second sentence of and adding two sentences at the end of 
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 medical source's report of the consultative 
examination should include the objective medical facts as well as 
observations and opinions.
    (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.
* * * * *

[[Page 11877]]

    (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 last sentence of 
paragraph (a) introductory text and the last sentence of paragraph (b) 
introductory text 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 a potentially life-
threatening situation, 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 the end of 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 in 
paragraphs (d)(2)(i) and (d)(2)(ii) of this section, 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 understanding 
of our disability programs and their evidentiary requirements that an 
acceptable medical source has, regardless of the source of that 
understanding, and the extent to which an acceptable medical source is 
familiar with the other information in your case record 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 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

[[Page 11878]]

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 as opinion evidence, except for the 
ultimate determination about whether you are disabled. See 
Sec. 404.1512(b)(6).
    (ii) When an administrative law judge considers findings of a State 
agency medical or psychological consultant or other program physician 
or psychologist, the administrative law judge will evaluate the 
findings using relevant factors in paragraphs (a) through (e) of this 
section, such as the physician's or psychologist's medical specialty 
and expertise in our rules, the supporting evidence in the case record, 
supporting explanations provided by the physician or psychologist, and 
any other factors relevant to the weighing of the opinions. Unless the 
treating source's opinion is given controlling weight, 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 other 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 republishing the introductory 
text, removing the terms ``Secretary,'' ``Source of record,'' and 
``You,'' revising the definitions of ``Medical sources'' and ``Treating 
source,'' and adding definitions in the appropriate alphabetical order 
for the terms ``Acceptable medical source,'' ``Nonexamining source,'' 
``Nontreating source,'' and ``You or your'' 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 (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

[[Page 11879]]

section) should describe, but are not limited to, the kinds of physical 
and mental capabilities listed as follows (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;
    (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; and
    (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 medical 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 
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. 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 text 
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 medical source 
designated to perform the consultative examination.

    28. Section 416.919n is amended by revising the section heading and 
the first and last sentences of the introductory text, adding a heading 
to paragraph (a), revising the first sentence of paragraph (a) 
introductory text, revising the last two sentences of paragraph (b), 
revising the second and third sentences of and adding two sentences at 
the end of paragraph (c)(6), 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

[[Page 11880]]

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 last sentence of 
paragraph (a) introductory text and the last sentence of paragraph (b) 
introductory text 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 a potentially life-
threatening situation, 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 the end of 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 in 
paragraphs (d)(2)(i) and (d)(2)(ii) of this section, 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 understanding 
of our disability programs and their evidentiary requirements that an 
acceptable medical source has, regardless of the source of that 
understanding, and the extent to which an acceptable medical source is 
familiar with the other information in your case record 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,

[[Page 11881]]

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 as opinion evidence, except for the ultimate 
determination about whether you are disabled. See Sec. 416.912(b)(6).
    (ii) When an administrative law judge considers findings of a State 
agency medical or psychological consultant or other program physician 
or psychologist, the administrative law judge will evaluate the 
findings using relevant factors in paragraphs (a) through (e) of this 
section, such as the physician's or psychologist's medical specialty 
and expertise in our rules, the supporting evidence in the case record, 
supporting explanations provided by the physician or psychologist, and 
any other factors relevant to the weighing of the opinions. Unless the 
treating source's opinion is given controlling weight, 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 other 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. 00-5035 Filed 3-6-00; 8:45 am]
BILLING CODE 4191-02-U