[Federal Register Volume 68, Number 204 (Wednesday, October 22, 2003)]
[Rules and Regulations]
[Pages 60290-60294]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-26623]


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RAILROAD RETIREMENT BOARD

20 CFR Part 220

RIN 3220-AA99


Determining Disability

AGENCY: Railroad Retirement Board.

ACTION: Final rule.

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SUMMARY: The Railroad Retirement Board (Board) updates its regulations 
to reflect a change in how it evaluates pain and other subjective 
symptoms when determining if an individual is disabled from all regular 
employment to reflect recent changes in law.

DATES: This rule is effective on October 22, 2003.

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

FOR FURTHER INFORMATION CONTACT: Marguerite P. Dadabo, Assistant 
General Counsel, (312) 751-4945, TDD (312) 751-4701.

SUPPLEMENTARY INFORMATION: Courts have consistently held that 
disability for all regular employment under section 2(a)(1)(v) of the 
Railroad Retirement Act (45 U.S.C. 231a(a)(1)(v)) is synonymous with 
the inability to perform any substantial gainful activity under section 
223(d) of the Social Security Act (42 U.S.C. 423(d)). Therefore, the 
Board has generally patterned its regulations dealing with the 
adjudication of claims for disability based upon the inability to 
engage in all regular employment (20 CFR Part 220) on regulations 
promulgated by the Social Security Administration (20 CFR Part 404, 
Subpart P). On November 14, 1991, the Social Security Administration 
published its final rule (56 FR 57928) expanding its regulations 
pertaining to how it evaluates symptoms, including pain, in its 
disability adjudication. The Board has generally followed these 
regulations in adjudication of claims for disability based on inability 
to engage in regular employment and now amends its regulations to 
conform thereto.
    Section 220.100(f) explains how a symptom, such as pain, is 
considered when it appears as a criterion in the Listing of Impairments 
found in Appendix 1 of this part. Appendix 1 contains medical criteria 
for finding a person disabled on medical factors alone without 
consideration of the person's age, education, and work experience.
    Section 220.112(a) is amended by eliminating the reference to 
remarried widow(ers) and surviving divorced spouses. Section 5103 of 
Public Law 101-508 revised the standard of disability for these groups 
of beneficiaries to require the consideration of other than medical 
factors, such as age, education, and experience, in determining 
disability for all substantial activity for these groups. Prior to the 
amendment, only medical factors were required to be used in a 
disability determination for these beneficiaries.
    Section 220.114 is revised to parallel the Social Security 
regulation dealing with the same subject. See Sec.  404.1529 of this 
chapter. Section 220.114 provides guidance on the evaluation of 
symptoms, including pain. The regulation conforms to the Board's 
current procedures and applicable court decisions on the evaluation of 
symptoms, especially pain, in making disability determinations.
    Section 220.114(a) is a general statement of how symptoms, such as 
pain, are considered in determining disability. It explains that the 
Board will consider a claimant's symptoms along with other objective 
medical evidence and other evidence relating to a claimant's condition.
    Section 220.114(b) explains that the Board will not find that pain 
will affect an individual's ability to do basic work activities unless 
the claimant first establishes that he or she has a medically 
determinable physical or mental impairment, supported by medical signs 
and laboratory findings, to which the allegation of pain can reasonably 
be related.
    Section 220.114(c) provides that when a symptom, such as pain, is 
established, the Board must then evaluate the intensity and persistence 
of the symptom with respect to how it limits the claimant's capacity 
for work. In making this evaluation the Board considers all available 
evidence, including the claimant's medical history, statements from the 
claimant and his treating physician, and statements from others who 
have knowledge of the claimant's situation.
    Section 220.114(d) explains how symptoms, such as pain, are 
evaluated in the sequential evaluation process required in disability 
adjudication.
    Section 220.120 is revised to explain that in determining the 
claimant's residual functional capacity the Board considers the 
claimant's symptoms, such as pain, and that such pain or other symptoms 
may limit the claimant's residual functional capacity beyond what can 
be determined from anatomical or physiological abnormalities taken 
alone. Consistent with the revision of Sec.  220.120, a new Sec.  
220.135 explains that a claimant's symptoms, such as pain, may cause 
both exertional and nonexertional limitations. This new section defines 
those terms. Only when the claimant's impairments and related symptoms 
impose solely exertional restrictions do the rules set forth in 
Appendix 2 of this part direct a conclusion.
    Appendix 2 contains the medical-vocational guidelines or ``grids''. 
The grids direct a finding of disabled or not disabled based on 
specified limitations combined with the individual's age, education and 
work experience. The amendment to Sec.  200.00 of Appendix 2 of this 
part conforms the section to the revised Sec.  220.120.

Collection of Information Requirements

    The amendments to this part do not impose information collection 
and recordkeeping requirements. Consequently, the final rule need not 
be reviewed by the Office of Management and Budget under the authority 
of the Paperwork Reduction Act of 1995.

Regulatory Impact Statement

    Prior to publication of this final rule, the Board submitted the 
rule to the Office of Management and Budget for review pursuant to 
Executive Order 12866. Executive Order 12866 directs agencies to assess 
all costs and benefits of available regulatory alternatives and when 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for rules that 
constitute significant regulatory action, including rules that have an 
economic effect of $100 million or more annually. This rule is not a 
major rule in terms of the aggregate costs involved. Specifically, we 
have determined that this rule is not a major rule with economically 
significant effects because it would not result in increases in total 
expenditures of $100 million or more per year.

[[Page 60291]]

    The amendments made by this rule are not significant. The 
amendments to sections of part 220 update the Board's regulations to 
reflect a change in the manner in which pain and other subjective 
symptoms are evaluated when determining if an individual is disabled 
from all regular employment. The amendments also clarify the use of 
Appendices 1 and 2, and make other amendments to reflect recent changes 
in law.
    Both the Regulatory Flexibility Act and the Unfunded Mandates Act 
of 1995 define ``agency'' by referencing the definition of ``agency'' 
contained in 5 U.S.C. 551(l). Section 551(1)(E) excludes from the term 
``agency'' an agency that is composed of representatives of the parties 
or of representatives of organizations of the parties to the disputes 
determined by them. The Railroad Retirement Board falls within this 
exclusion (45 U.S.C. 231f(a)) and is therefore exempt from the 
Regulatory Flexibility Act and the Unfunded Mandates Act.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a rule that imposes substantial 
direct compliance costs on State and local government, preempts State 
law, or otherwise has Federalism implications. We have reviewed this 
final rule under the threshold criteria of Executive Order 13132 and 
have determined that it would not have a substantial direct effect on 
the rights, roles, and responsibilities of States or local governments.
    The proposed rule was published in the Federal Register on 
September 11, 1995 (60 FR 47122). Comments were solicited and one was 
received. That commenter suggested that the Board could strengthen its 
disability program by establishing a mechanism for reevaluating an 
individual's entitlement to disability annuities being paid by the 
Board. The Board has an active program of reevaluating disability 
annuitants by its continuing disability review program. The guidelines 
for that program are set forth in Sec.  220.186 of this part.
    The Board has modified the proposed rule by removing the suggested 
addition of a paragraph (g) to Sec.  220.110 and a paragraph (d) to 
Sec.  220.134. That proposed text has been removed as it was 
inconsistent with regulations governing the cross-referencing by one 
agency to the regulations of another agency. See 1 CFR 21.21(c).

List of Subjects in 20 CFR Part 220

    Railroad retirement.


0
For the reasons set out in the preamble, the Railroad Retirement Board 
amends part 220 of title 20 of the Code of Federal Regulations as 
follows:

PART 220--DETERMINING DISABILITY

0
1. The authority citation for part 220 continues to read as follows:

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

0
2. Section 220.110 is amended by adding a new paragraph (f) to read as 
follows:


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

* * * * *
    (f) Symptoms as criteria of listed impairment(s). Some listed 
impairment(s) include symptoms usually associated with those 
impairment(s) as criteria. Generally, when a symptom is one of the 
criteria in a listed impairment, it is only necessary that the symptom 
be present in combination with the other criteria. It is not necessary, 
unless the listing specifically states otherwise, to provide 
information about the intensity, persistence or limiting effects of the 
symptom as long as all other findings required by the specific listing 
are present.

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3. The penultimate sentence of Sec.  220.112(a) is revised to read as 
follows:


Sec.  220.112  Conclusions by physicians concerning the claimant's 
disability.

    (a) * * * The decision as to whether a claimant is disabled may 
involve more than medical considerations and the Board may have to 
consider such factors as age, education and past work experience. * * *

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4. Section 220.114 is revised to read as follows:


Sec.  220.114  Evaluation of symptoms, including pain.

    (a) General. In determining whether the claimant is disabled, the 
Board considers all of the claimant's symptoms, including pain, and the 
extent to which the claimant's symptoms can reasonably be accepted as 
consistent with the objective medical evidence and other evidence. By 
objective medical evidence, the Board means medical signs and 
laboratory findings as defined in Sec. Sec.  220.113(b) and (c) of this 
part. By other evidence, the Board means the kinds of evidence 
described in Sec. Sec.  220.45 and 220.46 of this part. These include 
statements or reports from the claimant, the claimant's treating or 
examining physician or psychologist, and others about the claimant's 
medical history, diagnosis, prescribed treatment, daily activities, 
efforts to work, and any other evidence showing how the claimant's 
impairment(s) and any related symptoms affect the claimant's ability to 
work. The Board will consider all of the claimant's statements about 
his or her symptoms, such as pain, and any description by the claimant, 
the claimant's physician, or psychologist, or other persons about how 
the symptoms affect the claimant's activities of daily living and 
ability to work. However, statements alone about the claimant's pain or 
other symptoms will not establish that the claimant is disabled; there 
must be medical signs and laboratory findings which show that the 
claimant has a medical impairment(s) which could reasonably be expected 
to produce the pain or other symptoms alleged and which, when 
considered with all of the other evidence (including statements about 
the intensity and persistence of the claimant's pain or other symptoms 
which may reasonably be accepted as consistent with the medical signs 
and laboratory findings), would lead to a conclusion that the claimant 
is disabled. In evaluating the intensity and persistence of the 
claimant's symptoms, including pain, the Board will consider all of the 
available evidence, including the claimant's medical history, the 
medical signs and laboratory findings and statements about how the 
claimant's symptoms affect the claimant. (Section 220.112(b) of this 
part explains how the Board considers opinions of the claimant's 
treating source and other medical opinions on the existence and 
severity of the claimant's symptoms, such as pain.) The Board will then 
determine the extent to which the claimant's alleged functional 
limitations and restrictions due to pain or other symptoms can 
reasonably be accepted as consistent with the medical signs and 
laboratory findings and other evidence to decide how the claimant's 
symptoms affect the claimant's ability to work.
    (b) Need for medically determinable impairment that could 
reasonably be expected to produce symptoms, such as pain. The 
claimant's symptoms, such as pain, fatigue, shortness of breath, 
weakness, or nervousness, will not be found to affect the claimant's 
ability to do basic work activities unless medical signs or laboratory 
findings show that a medically determinable impairment(s) is present. 
Medical signs and laboratory findings, established by medically 
acceptable clinical or laboratory diagnostic techniques, must show the 
existence of a medical impairment(s) which results from anatomical, 
physiological, or psychological

[[Page 60292]]

abnormalities and which could reasonably be expected to produce the 
pain or other symptoms alleged. The finding that the claimant's 
impairment(s) could reasonably be expected to produce the claimant's 
pain or other symptoms does not involve a determination as to the 
intensity, persistence, or functionally limiting effects of the 
claimant's symptoms. The Board will develop evidence regarding the 
possibility of a medically determinable mental impairment when the 
Board has information to suggest that such an impairment exists, and 
the claimant alleges pain or other symptoms but the medical signs and 
laboratory findings do not substantiate any physical impairment(s) 
capable of producing the pain or other symptoms.
    (c) Evaluating the intensity and persistence of symptoms, such as 
pain, and determining the extent to which the claimant's symptoms limit 
his or her capacity for work.--(1) General. When the medical signs or 
laboratory findings show that the claimant has a medically determinable 
impairment(s) that could reasonably be expected to produce the 
claimant's symptoms, such as pain, the Board must then evaluate the 
intensity and persistence of the claimant's symptoms so that it can 
determine how the claimant's symptoms limit the claimant's capacity for 
work. In evaluating the intensity and persistence of the claimant's 
symptoms, the Board considers all of the available evidence, including 
the claimant's medical history, the medical signs and laboratory 
findings, and statements from the claimant, the claimant's treating or 
examining physician or psychologist, or other persons about how the 
claimant's symptoms affect the claimant. The Board also considers the 
medical opinions of the claimant's treating source and other medical 
opinions as explained in Sec.  220.112 of this part. Paragraphs (c)(2) 
through (c)(4) of this section explain further how the Board evaluates 
the intensity and persistence of the claimant's symptoms and how it 
determines the extent to which the claimant's symptoms limit the 
claimant's capacity for work, when the medical signs or laboratory 
findings show that the claimant has a medically determinable 
impairment(s) that could reasonably be expected to produce the 
claimant's symptoms, such as pain.
    (2) Consideration of objective medical evidence. Objective medical 
evidence is evidence obtained from the application of medically 
acceptable clinical and laboratory diagnostic techniques, such as 
evidence of reduced joint motion, muscle spasm, sensory deficit or 
motor disruption. Objective medical evidence of this type is a useful 
indicator to assist the Board in making reasonable conclusions about 
the intensity and persistence of the claimant's symptoms and the effect 
those symptoms, such as pain, may have on the claimant's ability to 
work. The Board must always attempt to obtain objective medical 
evidence and, when it is obtained, the Board will consider it in 
reaching a conclusion as to whether the claimant is disabled. However, 
the Board will not reject the claimant's statements about the intensity 
and persistence of the claimant's pain or other symptoms or about the 
effect the claimant's symptoms have on the claimant's ability to work 
solely because the available objective medical evidence does not 
substantiate the claimant's statements.
    (3) Consideration of other evidence. Since symptoms sometimes 
suggest a greater severity of impairment than can be shown by objective 
medical evidence alone, the Board will carefully consider any other 
information the claimant may submit about his or her symptoms. The 
information that the claimant, the claimant's treating or examining 
physician or psychologist, or other persons provide about the 
claimant's pain or other symptoms (e.g., what may precipitate or 
aggravate the claimant's symptoms, what medications, treatments or 
other methods he or she uses to alleviate them, and how the symptoms 
may affect the claimant's pattern of daily living) is also an important 
indicator of the intensity and persistence of the claimant's symptoms. 
Because symptoms, such as pain, are subjective and difficult to 
quantify, any symptom-related functional limitations and restrictions 
which the claimant, his or her treating or examining physician or 
psychologist, or other persons report, which can reasonably be accepted 
as consistent with the objective medical evidence and other evidence, 
will be taken into account as explained in paragraph (c)(4) of this 
section in reaching a conclusion as to whether the claimant is 
disabled. The Board will consider all of the evidence presented, 
including information about the claimant's prior work record, the 
claimant's statements about his or her symptoms, evidence submitted by 
the claimant's treating, examining or consulting physician or 
psychologist, and observations by Board employees and other persons. 
Section 220.112 of this part explains in detail how the Board considers 
and weighs treating source and other medical opinions about the nature 
and severity of the claimant's impairment(s) and any related symptoms, 
such as pain. Factors relevant to the claimant's symptoms, such as 
pain, which the Board will consider include:
    (i) The claimant's daily activities;
    (ii) The location, duration, frequency, and intensity of the 
claimant's pain or other symptoms;
    (iii) Precipitating and aggravating factors;
    (iv) The type, dosage, effectiveness, and side effects of any 
medication the claimant takes or has taken to alleviate the claimant's 
pain or other symptoms;
    (v) Treatment, other than medication, the claimant receives or has 
received for relief of pain or other symptoms;
    (vi) Any measures the claimant uses or has used to relieve pain or 
other symptoms (e.g., lying flat on the claimant's back, standing for 
15 to 20 minutes every hour, sleeping on a board, etc.); and
    (vii) Other factors concerning the claimant's functional 
limitations and restrictions due to pain or other symptoms.
    (4) How the Board determines the extent to which symptoms, such as 
pain, affect the claimant's capacity to perform basic work activities. 
In determining the extent to which the claimant's symptoms, such as 
pain, affect the claimant's capacity to perform basic work activities, 
the Board considers all of the available evidence described in 
paragraphs (c)(1) through (c)(3) of this section. The Board will 
consider the claimant's statements about the intensity, persistence, 
and limiting effects of the claimant's symptoms, and the Board will 
evaluate the claimant's statements in relation to the objective medical 
evidence and other evidence, in reaching a conclusion as to whether the 
claimant is disabled. The Board will consider whether there are any 
inconsistencies in the evidence and the extent to which there are any 
conflicts between the claimant's statements and the rest of the 
evidence, including the claimant's medical history, the medical signs 
and laboratory findings, and statements by the claimant's treating or 
examining physician or psychologist or other persons about how the 
claimant's symptoms affect the claimant. The claimant's symptoms, 
including pain, will be determined to diminish the claimant's capacity 
for basic work activities to the extent that the claimant's alleged 
functional limitations and restrictions due to symptoms, such as pain, 
can reasonably be accepted as consistent with the objective medical 
evidence and other evidence.
    (d) Consideration of symptoms in the disability determination 
process. The Board follows a set order of steps to determine whether 
the claimant is

[[Page 60293]]

disabled. If the claimant is not doing substantial gainful activity, 
the Board considers the claimant's symptoms, such as pain, to evaluate 
whether the claimant has a severe physical or mental impairment(s), and 
at each of the remaining steps in the process. Section 220.100 explains 
this process in detail. The Board also considers the claimant's 
symptoms, such as pain, at the appropriate steps in the Board's review 
when the Board considers whether the claimant's disability continues. 
Subpart O of this part explains the procedure the Board follows in 
reviewing whether the claimant's disability continues.
    (1) Need to establish a severe medically determinable 
impairment(s). The claimant's symptoms, such as pain, fatigue, 
shortness of breath, weakness, or nervousness, are considered in making 
a determination as to whether the claimant's impairment or combination 
of impairment(s) is severe. (See Sec.  220.100(b)(2) of this part).
    (2) Decision whether the Listing of Impairments is met. Some listed 
impairment(s) include symptoms, such as pain, as criteria. Section 
220.100(f) of this part explains how the Board considers the claimant's 
symptoms when the claimant's symptoms are included as criteria for a 
listed impairment.
    (3) Decision whether the Listing of Impairments is equaled. If the 
claimant's impairment is not the same as a listed impairment, the Board 
must determine whether the claimant's impairment(s) is medically 
equivalent to a listed impairment. Section 220.111 of this part 
explains how the Board makes this determination. Under Sec.  220.111(b) 
of this part, the Board will consider equivalence based on medical 
evidence only. In considering whether the claimant's symptoms, signs, 
and laboratory findings are medically equal to the symptoms, signs, and 
laboratory findings of a listed impairment, the Board will look to see 
whether the claimant's symptoms, signs, and laboratory findings are at 
least equal in severity to the listed criteria. However, the Board will 
not substitute the claimant's allegations of pain or other symptoms for 
a missing or deficient sign or laboratory finding to raise the severity 
of the claimant's impairment(s) to that of a listed impairment. If the 
symptoms, signs, and laboratory findings of the claimant's 
impairment(s) are equivalent in severity to those of a listed 
impairment, the Board will find the claimant disabled. If it does not, 
the Board will consider the impact of the claimant's symptoms on the 
claimant's residual functional capacity. (See paragraph (d)(4) of this 
section.)
    (4) Impact of symptoms (including pain) on residual functional 
capacity. If the claimant has a medically determinable severe physical 
or mental impairment(s), but the claimant's impairment(s) does not meet 
or equal an impairment listed in Appendix 1 of this part, the Board 
will consider the impact of the claimant's impairment(s) and any 
related symptoms, including pain, on the claimant's residual functional 
capacity. (See Sec.  220.120 of this part.)

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5. Section 220.120 is revised to read as follows:


Sec.  220.120  The claimant's residual functional capacity.

    (a) General. The claimant's impairment(s), and any related 
symptoms, such as pain, may cause physical and mental limitations that 
affect what the claimant can do in a work setting. The claimant's 
residual functional capacity is what the claimant can still do despite 
the claimant's limitations. If the claimant has more than one 
impairment, the Board will consider all of the claimant's impairment(s) 
of which the Board is aware. The Board will consider the claimant's 
ability to meet certain demands of jobs, such as physical demands, 
mental demands, sensory requirements, and other functions, as described 
in paragraphs (b), (c), and (d) of this section. Residual functional 
capacity is an assessment based upon all of the relevant evidence. It 
may include descriptions (even the claimant's own) of limitations that 
go beyond the symptoms, such as pain, that are important in the 
diagnosis and treatment of the claimant's medical condition. 
Observations by the claimant's treating or examining physicians or 
psychologists, the claimant's family, neighbors, friends, or other 
persons, of the claimant's limitations, in addition to those 
observations usually made during formal medical examinations, may also 
be used. These descriptions and observations, when used, must be 
considered along with the claimant's medical records to enable us to 
decide to what extent the claimant's impairment(s) keeps the claimant 
from performing particular work activities. This assessment of the 
claimant's remaining capacity for work is not a decision on whether the 
claimant is disabled, but is used as the basis for determining the 
particular types of work the claimant may be able to do despite the 
claimant's impairment(s). Then, using the guidelines in Sec. Sec.  
220.125 and 220.134 of this part the claimant's vocational background 
is considered along with the claimant's residual functional capacity in 
arriving at a disability determination or decision. In deciding whether 
the claimant's disability continues or ends, the residual functional 
capacity assessment may also be used to determine whether any medical 
improvement the claimant has experienced is related to the claimant's 
ability to work as discussed in Sec.  220.178 of this part.
    (b) Physical abilities. When the Board assesses the claimant's 
physical abilities, the Board first assesses the nature and extent of 
the claimant's physical limitations and then determines the claimant's 
residual functional capacity for work activity on a regular and 
continuing basis. A limited ability to perform certain physical demands 
of work activity, such as sitting, standing, walking, lifting, 
carrying, pushing, pulling, or other physical functions (including 
manipulative or postural functions, such as reaching, handling, 
stooping or crouching), may reduce the claimant's ability to do past 
work and other work.
    (c) Mental abilities. When the Board assesses the claimant's mental 
abilities, the Board first assesses the nature and extent of the 
claimant's mental limitations and restrictions and then determines the 
claimant's residual functional capacity for work activity on a regular 
and continuing basis. A limited ability to carry out certain mental 
activities, such as limitations in understanding, remembering, and 
carrying out instructions, and in responding appropriately to 
supervision, co-workers, and work pressures in a work setting, may 
reduce the claimant's ability to do past work and other work.
    (d) Other abilities affected by impairment(s). Some medically 
determinable impairment(s), such as skin impairment(s), epilepsy, 
impairment(s) of vision, hearing or other senses, and impairment(s) 
which impose environmental restrictions, may cause limitations and 
restrictions which affect other work-related abilities. If the claimant 
has this type of impairment(s), the Board considers any resulting 
limitations and restrictions which may reduce the claimant's ability to 
do past work and other work in deciding the claimant's residual 
functional capacity.
    (e) Total limiting effects. When the claimant has a severe 
impairment(s), but the claimant's symptoms, signs, and laboratory 
findings do not meet or equal those of a listed impairment in Appendix 
1 of this part, the Board will consider the limiting effects of all of 
the claimant's impairment(s), even those that are not severe, in 
determining the claimant's residual functional capacity.

[[Page 60294]]

Pain or other symptoms may cause a limitation of function beyond that 
which can be determined on the basis of the anatomical, physiological 
or psychological abnormalities considered alone; e.g., someone with a 
low back disorder may be fully capable of the physical demands 
consistent with those of sustained medium work activity, but another 
person with the same disorder, because of pain, may not be capable of 
more than the physical demands consistent with those of light work 
activity on a sustained basis. In assessing the total limiting effects 
of the claimant's impairment(s) and any related symptoms, the Board 
will consider all of the medical and nonmedical evidence, including the 
information described in Sec.  220.114 of this part.

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6. A new Sec.  220.135 is added to Subpart K to read as follows:


Sec.  220.135  Exertional and nonexertional limitations.

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

Appendix 2 to Part 220--Medical-Vocational Guidelines

0
7. Revise section 200.00(c) of Appendix 2 to part 220--Medical-
Vocational Guidelines to read as follows:
    200.00 Introduction.
* * * * *
    (c) In the application of the rules, the individual's residual 
functional capacity (i.e., the maximum degree to which the individual 
retains the capacity for sustained performance of the physical-mental 
requirements of jobs), age, education, and work experience must first 
be determined. When assessing the person's residual functional 
capacity, the Board considers his or her symptoms (such as pain), 
signs, and laboratory findings together with other evidence the Board 
obtains.
* * * * *

    Dated: October 16, 2003.

    By Authority of the Board.
Beatrice Ezerski,
Secretary to the Board.
[FR Doc. 03-26623 Filed 10-21-03; 8:45 am]
BILLING CODE 7905-01-P