[Federal Register Volume 68, Number 202 (Monday, October 20, 2003)]
[Notices]
[Pages 59971-59976]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-26332]


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SOCIAL SECURITY ADMINISTRATION

[Social Security Ruling, SSR 03-2p]


Titles II and XVI: Evaluating Cases Involving Reflex Sympathetic 
Dystrophy Syndrome/Complex Regional Pain Syndrome

AGENCY: Social Security Administration.

ACTION: Notice of Social Security Ruling.

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SUMMARY: In accordance with 20 CFR 402.35(b)(1), the Commissioner of 
Social Security gives notice of Social Security

[[Page 59972]]

Ruling, SSR 03-2p. This Ruling explains the policies of the Social 
Security Administration for developing and evaluating title II and 
title XVI claims for disability on the basis of Reflex Sympathetic 
Dystrophy Syndrome (RSDS), also frequently known as Complex Regional 
Pain Syndrome, Type I (CRPS). These terms are synonymous and are used 
to describe a unique clinical syndrome that may develop following 
trauma. This syndrome is characterized by complaints of intense pain 
and typically includes signs of autonomic dysfunction.

EFFECTIVE DATE: October 20, 2003.

FOR FURTHER INFORMATION CONTACT: Carolyn Kiefer, Office of Disability 
Programs, Social Security Administration, 6401 Security Boulevard, 
Baltimore, MD 21235-6401, (410) 965-9104 or TTY (410) 966-5609. For 
information on eligibility or filing for benefits, call our national 
toll-free number, 1-800-772-1213 or TTY 1-800-325-0778, or visit our 
Internet Web site, Social Security Online, at http://www.socialsecurity.gov.

SUPPLEMENTARY INFORMATION: Although we are not required to do so 
pursuant to 5 U.S.C. 552(a)(1) and (a)(2), we are publishing this 
Social Security Ruling in accordance with 20 CFR 402.35(b)(1).
    Social Security Rulings make available to the public precedential 
decisions relating to the Federal old-age, survivors, disability, 
supplemental security income, and black lung benefits programs. Social 
Security Rulings may be based on case decisions made at all 
administrative levels of adjudication, Federal court decisions, 
Commissioner's decisions, opinions of the Office of the General 
Counsel, and policy interpretations of the law and regulations.
    Although Social Security Rulings do not have the same force and 
effect as the statute or regulations, they are binding on all 
components of the Social Security Administration, in accordance with 20 
CFR 402.35(b)(1), and are relied upon as precedents in adjudicating 
cases.
    If this Social Security Ruling is later superseded, modified, or 
rescinded, we will publish a notice in the Federal Register to that 
effect.

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

    Dated: October 8, 2003.
Jo Anne B. Barnhart,
Commissioner of Social Security.

Policy Interpretation Ruling

Titles II and XVI: Evaluating Cases Involving Reflex Sympathetic 
Dystrophy Syndrome/Complex Regional Pain Syndrome

    Purpose: To explain the policies of the Social Security 
Administration for developing and evaluating title II and title XVI 
claims for disability on the basis of Reflex Sympathetic Dystrophy 
Syndrome (RSDS), also frequently known as Complex Regional Pain 
Syndrome, Type I (CRPS). These terms are synonymous and are used to 
describe a unique clinical syndrome that may develop following trauma. 
This syndrome is characterized by complaints of intense pain and 
typically includes signs of autonomic dysfunction.
    Citations (Authority): Sections 216(i), 223(d), 1614(a)(3), 
1614(a)(4) and 1614(c) of the Social Security Act (the Act), as 
amended; Regulations No. 4, subpart P, sections 404.1502, 404.1505, 
404.1508-404.1509, 404.1511-404.1513, 404.1520, 404.1520a, 404.1521, 
404.1523, 404.1526-404.1530, 404.1545-404.1546, 404.1560-404.1569a; and 
404.1593-404.1594 and appendix 1; and Regulations No. 16, subpart I, 
sections 416.902, 416.905, 416.906, 416.908-416.909, 416.911-416.913, 
416.920, 416.920a, 416.921, 416.923, 416.924, 416.924a-416.924c, 
416.925, 416.926, 416.926a, 416.927-416.930, 416.945-416.946, 416.960-
416.969a, 416.987, and 416.993-416.994a.
    Introduction: RSDS/CRPS are terms used to describe a constellation 
of symptoms and signs that may occur following an injury to bone or 
soft tissue. The precipitating injury may be so minor that the 
individual does not even recall sustaining an injury. Other potential 
precipitants suggested by the medical literature include, but are not 
limited to, surgical procedures, drug exposure, stroke with hemiplegia, 
and cervical spondylosis.

Policy Interpretation

What Is RSDS/CRPS?

    RSDS/CRPS is a chronic pain syndrome most often resulting from 
trauma to a single extremity. It can also result from diseases, 
surgery, or injury affecting other parts of the body. Even a minor 
injury can trigger RSDS/CRPS. The most common acute clinical 
manifestations include complaints of intense pain and findings 
indicative of autonomic dysfunction at the site of the precipitating 
trauma. Later, spontaneously occurring pain may be associated with 
abnormalities in the affected region involving the skin, subcutaneous 
tissue, and bone. It is characteristic of this syndrome that the degree 
of pain reported is out of proportion to the severity of the injury 
sustained by the individual. When left untreated, the signs and 
symptoms of the disorder may worsen over time.
    Although the pathogenesis of this disorder (the precipitating 
mechanism(s) of the signs and symptoms characteristic of RSDS/CRPS) has 
not been defined, dysfunction of the sympathetic nervous system has 
been strongly implicated.
    The sympathetic nervous system regulates the body's involuntary 
physiological responses to stressful stimuli. Sympathetic stimulation 
results in physiological changes that prepare the body to respond to a 
stressful stimulus by ``fight or flight.'' The so-called ``fight or 
flight'' response is characterized by constriction of peripheral 
vasculature (blood vessels supplying skin), increase in heart rate and 
sweating, dilatation of bronchial tubes, dilatation of pupils, increase 
in level of alertness, and constriction of sphincter musculature.
    Abnormal sympathetic nervous system function may produce 
inappropriate or exaggerated neural signals that may be misinterpreted 
as pain. In addition, abnormal sympathetic stimulation may produce 
changes in blood vessels, skin, musculature and bone. Early recognition 
of the syndrome and prompt treatment, ideally within 3 months of the 
first symptoms, provides the greatest opportunity for effective 
recovery.

How Does RSDS/CRPS Typically Present?

    RSDS/CRPS patients typically report persistent, burning, aching or 
searing pain that is initially localized to the site of the injury. The 
involved area usually has increased sensitivity to touch. The degree of 
reported pain is often out of proportion to the severity of the 
precipitating injury. Without appropriate treatment, the pain and 
associated atrophic skin and bone changes may spread to involve an 
entire limb. Cases have been reported to progress and spread to other 
limbs, or to remote parts of the body.
    Clinical studies have demonstrated that when treatment is delayed, 
the signs and symptoms may progress and spread, resulting in long-term 
and even permanent physical and psychological problems. Some 
investigators have found that the signs and symptoms of

[[Page 59973]]

RSDS/CRPS persist longer than 6 months in 50 percent of cases, and may 
last for years in cases where treatment is not successful.

What Are the Diagnostic Criteria for RSDS/CRPS?

    A diagnosis of RSDS/CRPS requires the presence of complaints of 
persistent, intense pain that results in impaired mobility of the 
affected region. The complaints of pain are associated with:
    [sbull] Swelling;
    [sbull] Autonomic instability--seen as changes in skin color or 
texture, changes in sweating (decreased or excessive sweating), skin 
temperature changes, or abnormal pilomotor erection (gooseflesh);
    [sbull] Abnormal hair or nail growth (growth can be either too slow 
or too fast);
    [sbull] Osteoporosis; or
    [sbull] Involuntary movements of the affected region of the initial 
injury.
    Progression of the clinical disorder is marked by worsening of a 
previously identified finding, or the manifestation of additional 
abnormal changes in the skin, nails, muscles, joints, ligaments, and 
bones of the affected region. Clinical progression does not necessarily 
correlate with specific timeframes. Efficacy of treatment must be 
judged on the basis of the treatment's effect on the pain and whether 
or not progressive changes continue in the tissues of the affected 
region.
    Reported pain at the site of the injury may be followed by 
complaints of muscle pain, joint stiffness, restricted mobility, or 
abnormal hair and nail growth in the affected region. Further, signs of 
autonomic instability (changes in the color or temperature of the skin 
and frequent appearance of goose bumps) may develop in the affected 
region. Osteoporosis may be noted by appropriate medically acceptable 
imaging techniques. Complaints of pain can further intensify, and can 
be reported to spread to involve other extremities. Muscle atrophy and 
contractures can also develop. Persistent clinical progression 
resulting in muscle atrophy and contractures, or progression of 
complaints of pain to include other extremities or regions, in spite of 
appropriate diagnosis and treatment, hallmark a poor prognosis.

How Is RSDS/CRPS Treated?

    Patient education and activity programs designed to increase limb 
mobility and promote use of the extremity or affected region during 
activities of daily living are considered the most important treatments 
for RSDS/CRPS. The medical literature has demonstrated that individuals 
affected by RSDS/CRPS have a better prognosis when they receive an 
early diagnosis and mobility is immediately encouraged. In some 
patients, it is necessary to inject a long-acting anesthetic to block 
sympathetic activity and reduce pain to allow the individual to 
increase the mobility of the affected region. Various analgesics, 
including narcotics and neurostimulators, may be used to minimize pain 
and promote the individual's ability to tolerate greater mobility.
    A mental evaluation may be requested by treating or other medical 
sources to determine if any undiagnosed psychiatric disease is present 
that could potentially contribute to a reduced pain tolerance. It is 
important to recognize that such evaluations are not based on concern 
that RSDS/CRPS findings are imaginary or etiologically linked to 
psychiatric disease. The behavioral and cognitive effects of the 
medications used to treat pain need to be thoroughly considered in the 
evaluation of this syndrome.
    Other types of medications may also be used to reduce pain. Anti-
inflammatory preparations, psychotropic medications (for example, 
antidepressants), certain antiepileptic drugs, muscle relaxants, and 
drugs that produce generalized reduction in sympathetic outflow may be 
tried in an effort to reduce the signs and symptoms associated with 
RSDS/CRPS and improve the mobility of the affected region.
    Patients who are noted to have a good response to local sympathetic 
blocks may be considered candidates for surgical sympathectomy. This 
procedure permanently disrupts the sympathetic innervation of the 
affected region. It involves destroying a sympathetic ganglion and must 
be performed by a physician who is an expert in this technique. This 
procedure is not without risk of post-surgical complications.

What Is a Medically Determinable Impairment?

    Sections 216(i) and 1614(a)(3) of the Act define ``disability'' \1\ 
as the inability to engage in any substantial gainful activity by 
reason of any medically determinable physical or mental impairment (or 
combination of impairments) which can be expected to result in death or 
which has lasted or can be expected to last for a continuous period of 
not less than 12 months.\2\
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    \1\ Except for statutory blindness.
    \2\ For individuals under age 18 claiming benefits under title 
XVI, disability will be established if the individual is suffering 
from a medically determinable physical or mental impairment (or 
combination of impairments) that results in ``marked and severe 
functional limitations.'' See section 1614(a)(3)(C) of the Act and 
20 CFR 416.906. However, for clarity, the following discussions 
refer only to claims of individuals claiming disability benefits 
under title II and individuals age 18 or older claiming disability 
benefits under title XVI. It should be understood that references in 
this Ruling to the ability to do substantial gainful activity, 
``RFC,'' and other terms and rules that are applicable only to title 
II disability claims and title XVI disability claims of individuals 
age 18 or older are also intended to refer to appropriate terms and 
rules applicable in determining disability for individuals under age 
18 under title XVI.
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    Sections 223(d)(3) and 1614(a)(3)(D) of the Act, and 20 CFR 
404.1508 and 416.908, require that impairment result from anatomical, 
physiological, or psychological abnormalities that can be shown by 
medically acceptable clinical and laboratory diagnostic techniques. The 
Act and regulations further require that impairment be established by 
medical evidence that consists of signs, symptoms, and laboratory 
findings, and not only by an individual's statement of symptoms.

How Is RSDS/CRPS Identified as a Medically Determinable Impairment?

    RSDS/CRPS constitutes a medically determinable impairment when it 
is documented by appropriate medical signs, symptoms, and laboratory 
findings, as discussed above. RSDS/CRPS may be the basis for a finding 
of ``disability.'' Disability may not be established on the basis of an 
individual's statement of symptoms alone.
    For purposes of Social Security disability evaluation, RSDS/CRPS 
can be established in the presence of persistent complaints of pain 
that are typically out of proportion to the severity of any documented 
precipitant and one or more of the following clinically documented 
signs in the affected region at any time following the documented 
precipitant:
    [sbull] Swelling;
    [sbull] Autonomic instability--seen as changes in skin color or 
texture, changes in sweating (decreased or excessive sweating), changes 
in skin temperature, and abnormal pilomotor erection (gooseflesh);
    [sbull] Abnormal hair or nail growth (growth can be either too slow 
or too fast);
    [sbull] Osteoporosis; or
    [sbull] Involuntary movements of the affected region of the initial 
injury.
    When longitudinal treatment records document persistent limiting 
pain in an area where one or more of these abnormal signs has been 
documented at

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some point in time since the date of the precipitating injury, 
disability adjudicators can reliably determine that RSDS/CRPS is 
present and constitutes a medically determinable impairment. It may be 
noted in the treatment records that these signs are not present 
continuously, or the signs may be present at one examination and not 
appear at another. Transient findings are characteristic of RSDS/CRPS, 
and do not affect a finding that a medically determinable impairment is 
present.

How Is Medical Evidence of the Impairment Documented?

    In cases involving RSDS/CRPS, the documentation of medical signs or 
laboratory findings at some point in time in the clinical record since 
the date of the precipitating injury is critical in establishing the 
presence of a medically determinable impairment. In cases in which 
RSDS/CRPS is alleged, longitudinal clinical records reflecting ongoing 
medical evaluation and treatment from the individual's medical sources, 
especially treating sources, are extremely helpful in documenting the 
presence of any medical signs, symptoms and laboratory findings.
    Generally, evidence for the 12-month period preceding the month of 
application should be obtained, unless there is reason to believe that 
development of an earlier period is necessary, the alleged onset of 
disability is less than 12 months before the date of the application, 
or a fully favorable determination can be made with less evidence.
    If the adjudicator finds that the evidence is inadequate to 
determine whether the individual is disabled, he or she must first 
recontact the individual's treating or other medical source(s) to 
determine whether the additional information needed is readily 
available, in accordance with 20 CFR 404.1512 and 416.912. Only after 
the adjudicator determines that the information is not readily 
available from the individual's health care provider(s), or that the 
necessary information or clarification cannot be sought from the 
individual's health care provider(s), should the adjudicator proceed to 
arrange for a consultative examination(s) in accordance with 20 CFR 
404.1519a and 416.919a. The type of consultative examination(s) 
purchased will depend on the nature of the individual's symptoms and 
the extent of the evidence already in the case record.
    It should be noted that conflicting evidence in the medical record 
is not unusual in cases of RSDS due to the transitory nature of its 
objective findings and the complicated diagnostic process involved. 
Clarification of any such conflicts in the medical evidence should be 
sought first from the individual's treating or other medical sources.
    Medical opinions from treating sources about the nature and 
severity of an individual's impairment(s) are entitled to deference and 
may be entitled to controlling weight. If we find that a treating 
source's medical opinion on the issue of the nature and severity of an 
individual's impairment(s) is well-supported by medically acceptable 
clinical and laboratory diagnostic techniques and is not inconsistent 
with the other substantial evidence in the case record, the adjudicator 
will give it controlling weight. (See SSR 96-2p, ``Titles II and XVI: 
Giving Controlling Weight to Treating Source Medical Opinions,'' and 
SSR 96-5p, ``Titles II and XVI: Medical Source Opinions on Issues 
Reserved to the Commissioner.'') \3\
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    \3\ A medical source opinion that an individual is ``disabled'' 
or ``unable to work,'' has an impairment(s) that meets or equals the 
requirements of a listing, has a particular residual functional 
capacity (RFC), that concerns whether an individual's RFC prevents 
him or her from doing past relevant work, or that concerns the 
application of vocational factors, is an opinion on an issue 
reserved to the Commissioner. Every such opinion must still be 
considered in adjudicating a disability claim; however, the 
adjudicator will not give any special significance to such an 
opinion because of its source. See SSR 96-5p for an additional 
discussion of this issue.
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How Is the Duration and Severity of RSDS/CRPS Established?

    The signs and symptoms of RSDS/CRPS may remain stable over time, 
improve, or worsen. Documentation should, whenever appropriate, include 
a longitudinal clinical record containing detailed medical 
observations, treatment, the individual's response to treatment, 
complications of treatment, and a detailed description of how the 
impairment limits the individual's ability to function and perform or 
sustain work activity over time.
    Chronic pain and many of the medications prescribed to treat it may 
affect an individual's ability to maintain attention and concentration, 
as well as adversely affect his or her cognition, mood, and behavior, 
and may even reduce motor reaction times. These factors can interfere 
with an individual's ability to sustain work activity over time, or 
preclude sustained work activity altogether. When evaluating duration 
and severity, as well as when evaluating RFC, the effects of chronic 
pain and the use of pain medications must be carefully considered.
    When the alleged onset of disability secondary to RSDS/CRPS 
occurred less than 12 months before adjudication, the adjudicator must 
evaluate the available medical evidence and project the degree of 
impairment severity that is likely to exist at the end of 12 months. 
Information about treatment and response to treatment, as well as any 
medical source opinions about the individual's prognosis at the end of 
12 months, are helpful in deciding whether the medically determinable 
impairment is expected to be of disabling severity for at least 12 
consecutive months.
    In those cases in which an individual is found disabled based on 
RSDS/CRPS, but medical improvement is anticipated, the adjudicator 
should schedule an appropriate medical reexamination date consistent 
with the information indicating the likelihood of medical improvement.

How Is RSDS/CRPS Evaluated?

    Claims in which the individual alleges RSDS/CRPS are adjudicated 
using the sequential evaluation process, just as for any other 
impairment. Because finding that RSDS/CRPS is a medically determinable 
impairment requires the presence of chronic pain and one or more 
clinically documented signs in the affected region, the adjudicator can 
reliably find that pain is an expected symptom in this disorder. Other 
symptoms, including such things as extreme sensitivity to touch or 
pressure, or abnormal sensations of heat or cold, can also be 
associated with this disorder. Given that a variety of symptoms can be 
associated with RSDS/CRPS, once the disorder has been established as a 
medically determinable impairment, the adjudicator must evaluate the 
intensity, persistence, and limiting effects of the individual's 
symptoms to determine the extent to which the symptoms limit the 
individual's ability to do basic work activities. For this purpose, 
whenever the individual's statements about the intensity, persistence, 
or functionally limiting effects of pain or other symptoms are not 
substantiated by objective medical evidence, the adjudicator must make 
a finding on the credibility of the individual's statements based on a 
consideration of the entire case record. This includes the medical 
signs and laboratory findings, the individual's own statements about 
the symptoms, any statements and other information provided by treating 
or examining physicians or psychologists and other persons about the 
symptoms and how they affect the individual, and any other relevant 
evidence in the case record. Although symptoms alone

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cannot be the basis for finding a medically determinable impairment, 
once the existence of a medically determinable impairment has been 
established, an individual's symptoms and the effect(s) of those 
symptoms on the individual's ability to function must be considered 
both in determining impairment severity and in assessing the 
individual's residual functional capacity (RFC), as appropriate. If the 
adjudicator finds that pain or other symptoms cause a limitation or 
restriction having more than a minimal effect on an individual's 
ability to perform basic work activities, a ``severe'' impairment must 
be found to exist. See SSR 96-3p, ``Titles II and XVI: Considering 
Allegations of Pain and Other Symptoms in Determining Whether a 
Medically Determinable Impairment is Severe'' and SSR 96-7p, ``Titles 
II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the 
Credibility of an Individual's Statements.''
    Proceeding with the sequential evaluation process, when an 
individual is found to have a medically determinable impairment that is 
``severe,'' the adjudicator must next consider whether the individual's 
impairment(s) meets or equals the requirements of the Listing of 
Impairments contained in appendix 1, subpart P of 20 CFR part 404. 
Since RSDS/CRPS is not a listed impairment, an individual with RSDS/
CRPS alone cannot be found to have an impairment that meets the 
requirements of a listed impairment. However, the specific findings in 
each case should be compared to any pertinent listing to determine 
whether medical equivalence may exist.\4\ Psychological manifestations 
related to RSDS/CRPS should be evaluated under the mental disorders 
listings, and consideration should be given as to whether the 
individual's impairment(s) meets or equals the severity of a mental 
listing.
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    \4\ In evaluating title XVI claims for disability benefits for 
individuals under age 18, consideration must be given to the 
possibility of finding functional equivalence based on the 
individual's impairment and related symptoms and their effects on 
whether the individual's impairment(s) results in marked and severe 
functional limitations.
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    For those cases in which the individual's impairment(s) does not 
meet or equal the listings, an assessment of RFC must be made, and 
adjudication must proceed to the fourth and, if necessary, the fifth 
step of the sequential evaluation process. Again, in determining RFC, 
all of the individual's symptoms must be considered in deciding how 
such symptoms may affect functional capacities. Careful consideration 
must be given to the effects of pain and its treatment on an 
individual's capacity to do sustained work-related physical and mental 
activities in a work setting on a regular and continuing basis. See SSR 
96-7p, ``Titles II and XVI: Evaluation of Symptoms in Disability 
Claims: Assessing the Credibility of an Individual's Statements'' and 
SSR 96-8p, ``Titles II and XVI: ``Assessing Residual Functional 
Capacity in Initial Claims.''
    Opinions from an individual's medical sources, especially treating 
sources, concerning the effect(s) of RSDS/CRPS on the individual's 
ability to function in a sustained manner in performing work 
activities, or in performing activities of daily living, are important 
in enabling adjudicators to draw conclusions about the severity of the 
impairment(s) and the individual's RFC. In this regard, any information 
a medical source is able to provide contrasting the individual's 
medical condition(s) and functional capacities since the alleged onset 
of RSDS/CRPS with the individual's status prior to the onset of RSDS/
CRPS is helpful to the adjudicator in evaluating the individual's 
impairment(s) and the resulting functional consequences.
    In cases involving RSDS/CRPS, third-party information, including 
evidence from medical practitioners who have provided services to the 
individual, and who may or may not be ``acceptable medical sources,'' 
is often critical in deciding the individual's credibility. Information 
other than an individual's allegations and reports from the 
individual's treating sources helps to assess an individual's ability 
to function on a day-to-day basis and helps to depict the individual's 
capacities over a period of time, thus serving to establish a 
longitudinal picture of the individual's status. Such evidence 
includes, but is not limited to:
    [sbull] Information from neighbors, friends, relatives, or clergy;
    [sbull] Statements from such individuals as past employers, 
rehabilitation counselors, or teachers about the individual's 
impairment(s) and the effects of the impairment(s) on the individual's 
functioning in the work place, rehabilitation facility, or educational 
institution;
    [sbull] Statements from other practitioners with knowledge of the 
individual, e.g., nurse-practitioners, physicians' assistants, 
naturopaths, therapists, social workers, and chiropractors;
    [sbull] Statements from other sources with knowledge of the 
individual's ability to function in daily activities; and
    [sbull] The individual's own record (such as a diary, journal, or 
notes) of his or her own impairment(s) and its impact on function over 
time.
    In accordance with SSR 96-7p, ``Titles II and XVI: Evaluation of 
Symptoms In Disability Claims: Assessing The Credibility of An 
Individual's Statements,'' when additional information is needed to 
assess the credibility of the individual's statements about symptoms 
and their effects, the adjudicator must make every reasonable effort to 
obtain additional information that could shed light on the credibility 
of the individual's statements.
    If the adjudicator determines that the individual's impairment(s) 
precludes the performance of past relevant work (or if there was no 
past relevant work), a finding must be made about the individual's 
ability to perform other work. The usual vocational considerations (see 
20 CFR 404.1560-404.1569a and 416.960-416.969a) must be followed in 
determining the individual's ability to perform other work. See also 
SSR 96-8p, ``Titles II and XVI: Assessing Residual Functional Capacity 
in Initial Claims.''
    Many individuals with RSDS/CRPS are ``younger individuals'' ages 18 
through 49 (see 20 CFR 404.1563 and 416.963). Age, education, and work 
experience are not usually considered to limit significantly the 
ability of individuals under age 50 to make an adjustment to other 
work, including unskilled sedentary work.\5\ However, a finding of 
``disabled'' is not precluded for those individuals under age 50 who do 
not meet all of the criteria of a specific rule and who do not have the 
ability to perform a full range of sedentary work. The conclusion about 
whether such individuals are disabled will depend primarily on the 
nature and extent of their functional limitations or restrictions. 
Thus, if it is determined that an individual is able to do less than 
the full range of sedentary work, refer to SSR 96-9p, ``Titles II and 
XVI: Determining Capability to Do Other Work--Implications of a 
Residual Functional Capacity for Less Than a Full Range of Sedentary 
Work.'' As explained in that Ruling, whether the individual will be 
able to make an adjustment to other work requires

[[Page 59976]]

adjudicative judgment regarding factors such as the type and extent of 
the individual's limitations or restrictions and the extent of the 
erosion of the occupational base for sedentary work.
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    \5\ However, ``younger individuals'' age 45-49 who are unable to 
communicate in English or who are illiterate in English, whose past 
work was unskilled (or who had no past relevant work), or who have 
no transferable skills, and who are limited to a full range of 
sedentary work must be found disabled under rule 201.17 in Table No. 
1 of appendix 2, of the Medical-Vocational Guidelines in 20 CFR part 
404.
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    Effective Date: This Ruling is effective on the date of its 
publication in the Federal Register.
    Cross-References: SSR 96-2p, ``Titles II and XVI: Giving 
Controlling Weight to Treating Source Medical Opinions,'' SSR 96-3p, 
``Titles II and XVI: Considering Allegations of Pain and Other Symptoms 
in Determining Whether a Medically Determinable Impairment is Severe,'' 
SSR 96-5p, ``Titles II and XVI: Medical Source Opinions on Issues 
Reserved to the Commissioner,'' SSR 96-7p, ``Titles II and XVI: 
Evaluation of Symptoms in Disability Claims: Assessing the Credibility 
of an Individual's Statements,'' SSR 96-8p, ``Titles II and XVI: 
Assessing Residual Functional Capacity in Initial Claims,'' and SSR 96-
9p, ``Titles II and XVI: Determining Capability to Do Other Work--
Implications of a Residual Functional Capacity for Less Than a Full 
Range of Sedentary Work.''

[FR Doc. 03-26332 Filed 10-17-03; 8:45 am]
BILLING CODE 4910-02-U